Information Collection

Form 4029

IC 16837 under ICR 202110-1545-011 · OMB 1545-0064.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0064 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4029 Form 4029	Form and Instruction
4029 Application for Exemption from Social Security and Medic Form 4029--2018-11-00.pdf	Form and Instruction
4029 Application for Exemption from Social Security and Medic Form 4029--2018-11-00.pdf	Form and Instruction

IC Title:

Form 4029

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 1.1402(h)-1 26 CFR 31.6053-1

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 and Instruction	4029	Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits	Form 4029--2018-11-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,754

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,754	3,754
Annual IC Time Burden (Hours)	3,792	3,792
Annual IC Cost Burden (Dollars)	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.