Information Collection

Responsible Individual Personal Attestation

IC 220963 under ICR 202101-1545-010 · OMB 1545-2266.

⚠️ Notice: This information collection may be referencing outdated material.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

2024-05-31 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
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

View Information Collection (IC)

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:

table that charts list of 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

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

table that charts IC Documents
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.