Information Collection

Form 5434, Application for Enrollment

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 5434, Application for Enrollment	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:

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 %

	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

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.