Information Collection

Form 5495

IC 129915 under ICR 202203-1545-001 · OMB 1545-0432.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0432 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5495 Form 5495	Form and Instruction
5495 Request for Discharge From Personal Liability Under Inte f5495--2008-12-00.pdf	Form and Instruction
5495 Request for Discharge From Personal Liability Under Inte f5495--2008-12-00.pdf	Form and Instruction

IC Title:

Form 5495

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 and Instruction	5495	Request for Discharge From Personal Liability Under Internal Revenue Code Section 2204 or 6905	f5495--2008-12-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS.34.037

FR Citation: 80 FR 54063

Number of Respondents: 1,800

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	25,000	25,000
Annual IC Time Burden (Hours)	306,500	306,500
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.