Information Collection

Form 14039-B - Business Identity Theft Affidavit

IC 188502 under ICR 202207-1545-010 · OMB 1545-2139.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2139 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 14039-B Form 14039-B - Business Identity Theft Affidavit	Form and Instruction
Form 14039-B Business Identity Theft Affidavit f14039-b--2021-05-00.pdf	Form and Instruction
Form 14039-B Business Identity Theft Affidavit f14039-b--2021-05-00.pdf	Form and Instruction
Form 14039-B (SP) Declaracion Jurada sobre el Robo de Identidad de un Nego f14039-b_sp--2021-05-00.pdf	Form and Instruction
Form 14039-B (SP) Declaracion Jurada sobre el Robo de Identidad de un Nego f14039-b_sp--2021-05-00.pdf	Form and Instruction

IC Title:

Form 14039-B - Business 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:

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	Form 14039-B	Business Identity Theft Affidavit	f14039-b--2021-05-00.pdf		Yes	No	Fillable Printable
Form and Instruction	Form 14039-B (SP)	Declaracion Jurada sobre el Robo de Identidad de un Negocio	f14039-b_sp--2021-05-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: Treas/IRS 24.046 â CADE Business Master File

FR Citation: 80 FR 54064

Number of Respondents: 75,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,000	-5,000	20,000
Annual IC Time Burden (Hours)	34,500	28,300	6,200
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.