Form 14039 - Identity Theft Affidavit

Identity Theft Affidavit and Business Identity Theft Affidavit

Documents and Forms

Document Name Document Type
Form Form 14039 Form 14039 - Identity Theft Affidavit Form and Instruction
Form 14039 Identity Theft Affidavit f14039--2022-03-00.pdf Form and Instruction
Form 14039 Identity Theft Affidavit f14039--2022-03-00.pdf Form and Instruction
Form 14039 (SP) Declaracion Jurada sobre el Robo de Identidad f14039_sp--2022-03-00.pdf Form and Instruction
Form 14039 (SP) Declaracion Jurada sobre el Robo de Identidad f14039_sp--2022-03-00.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Form 14039 - Identity Theft Affidavit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 14039	Identity Theft Affidavit	f14039--2022-03-00.pdf		Yes	No	Fillable Printable
Form and Instruction	Form 14039 (SP)	Declaracion Jurada sobre el Robo de Identidad	f14039_sp--2022-03-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: Treas/IRS 24.030 CADE Individual Master File (IMF)	FR Citation: 80 FR 54064

Number of Respondents: 354,501	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	354,501	-27,932	382,433
Annual IC Time Burden (Hours)	850,802	342,166	508,636
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.