Information Collection

Statements for employees

IC 19238 under ICR 201911-1545-022 · OMB 1545-1729.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1729 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
REG-107186-00.pdf REG-107186-00	IC Document
TD 9114.pdf TD 9114	IC Document

IC Title:

Statements for employees

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 26 CFR 1.6041-2 26 CFR 1.6041-2T 26 CFR 31.6051-1 26 CFR 1.6050S-4 26 CFR 1.6050S-2

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	28,449,495	28,449,495
Annual IC Time Burden (Hours)	2,844,950	2,844,950
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REG-107186-00	REG-107186-00.pdf	11/29/2019
TD 9114	TD 9114.pdf	11/29/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.