Information Collection

Form 5434, Application for Enrollment

IC 39888 under ICR 202305-1545-012 · OMB 1545-0951.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 5434 Form 5434, Application for Enrollment	Form and Instruction
Form 5434 Joint Board for the Enrollment of Actuaries Application Form 5434 (Rev. 10-2021).pdf www.pay.gov	Form and Instruction
Form 5434 Joint Board for the Enrollment of Actuaries Application Form 5434 (Rev. 10-2021).pdf www.pay.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 901

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 5434	Joint Board for the Enrollment of Actuaries Application for Enrollment	Form 5434 (Rev. 10-2021).pdf	www.pay.gov	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS 24.030-CADE Individual Master File and IRS 34.037 IRS Audit Trail and Security Records System

FR Citation: 83 FR 42980

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	-250	400
Annual IC Time Burden (Hours)	150	-250	400
Annual IC Cost Burden (Dollars)	37,500	37,500	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.