Responsible Individual Personal Attestation

Certified Professional Employer Organization (CPEO) Forms: 14737,14737-A,14751, 8973 and TD 9860

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2266 can be found here:

Documents and Forms

Document Name Document Type
Form 14737-A Responsible Individual Personal Attestation Form
14737-A CPEO Responsible Individual Personal Attestation.pdf CPEO Responsible Individual Personal Attestation.pdf Form
14737-A CPEO Responsible Individual Personal Attestation.pdf CPEO Responsible Individual Personal Attestation.pdf Form

Information Collection (IC) Details

IC Title:	Responsible Individual Personal Attestation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	14737-A	CPEO Responsible Individual Personal Attestation.pdf	CPEO Responsible Individual Personal Attestation.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: Certified Professional Employer Organization and 501(c)(4) Registration, CPEO & 501 (c)(4), and a Privacy Act System of Records notice (SORN) has been issued for this system under IRS PCLIA ID Number	FR Citation: 81 FR 44924

Number of Respondents: 565	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	565	-435	1,000
Annual IC Time Burden (Hours)	11,300	-28,700	40,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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