Revenue Procedure 2017-15, Qualified Intermediary Agreement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 14345 Application for Qualified Intermediary, Withholding	Form and Instruction	Modified	Repair queued
Form 14345 Revenue Procedure 2017-15, Qualified Intermediary Agreement	Form and Instruction	Modified	Repair queued
SUP STAT_1545-1597 (2021).docx	Supporting Statement A	Uploaded 2021-09-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
18868	Revenue Procedure 2017-15, Qualified Intermediary Agreement	Form and Instruction	Modified	Application for Qualified Intermediary, Withholding
18868	Revenue Procedure 2017-15, Qualified Intermediary Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 1545-1597	ICR Reference No: 202105-1545-015
Status: Historical Active	Previous ICR Reference No: 201805-1545-001
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Revenue Procedure 2017-15, Qualified Intermediary Agreement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/22/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/29/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	36 Months From Approved	11/30/2021
Responses	1,097,991	0	1,097,991
Time Burden (Hours)	301,018	0	301,018
Cost Burden (Dollars)	0	0	0

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Abstract: Revenue Procedure 2017-15 describes application procedures for becoming a qualified intermediary and the requisite agreement that a qualified intermediary must execute with the IRS. The information will be used by the IRS to ensure compliance with the U.S. withholding system under the 1441 regulations (especially proper entitlement to treaty benefits).

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Authorizing Statute(s): US Code: 26 USC 1441 Name of Law: Withholding of tax on nonresident aliens.
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 29626	06/02/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53730	09/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Revenue Procedure 2017-15, Qualified Intermediary Agreement	14345	Application for Qualified Intermediary, Withholding

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,097,991	1,097,991	0	0	0	0
Annual Time Burden (Hours)	301,018	301,018	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/29/2021

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