Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act and IRS Request for Individual Access to Non-Tax Records under the Privacy Act

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 15603 IRS Request for Individual Access to Non-Tax Records under the Privacy Act	Form and Instruction	New	Available
Form 15603 IRS Request for Individual Access to Non-Tax Records under the Privacy Act	Form and Instruction	New	Repair queued
Form 15293 Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act	Form and Instruction	New	Available
Form 15293 Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act	Form and Instruction	New	Repair queued
OMB 1545-XXXX (new form 15293_15603) SS-clean.docx	Supporting Statement A	Uploaded 2024-04-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
266204	IRS Request for Individual Access to Non-Tax Records under the Privacy Act	Form and Instruction	New	IRS Request for Individual Access to Non-Tax Records under the Privacy Act
266204	IRS Request for Individual Access to Non-Tax Records under the Privacy Act	Form and Instruction	New
266171	Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act	Form and Instruction	New	Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act
266171	Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act	Form and Instruction	New

ICR Details

OMB Control No: 1545-2324	ICR Reference No: 202403-1545-014
Status: Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act and IRS Request for Individual Access to Non-Tax Records under the Privacy Act
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/06/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved
Responses	600	0	0
Time Burden (Hours)	150	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Form 15293 is used to grant permissions for disclosure of non-tax personal information. This form may be used by the parent consenting to and authorizing disclosure of the records of a minor or the legal guardian consenting to and authorizing disclosures of the records of an incompetent. Form 15603 is used to request access to non-tax records from a Privacy Act System of Records. This form may also be used by the parent seeking access to the records of a minor or the legal guardian seeking access to the records of an incompetent.

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Authorizing Statute(s): US Code: 5 USC 522a Name of Law: Records maintained on individuals
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 86219	12/12/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 35927	05/02/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act	15293	Consent for Disclosure of Non-Tax IRS Records Protected under the Privacy Act
IRS Request for Individual Access to Non-Tax Records under the Privacy Act	15603	IRS Request for Individual Access to Non-Tax Records under the Privacy Act

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	600	0	0	600	0	0
Annual Time Burden (Hours)	150	0	0	150	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Form 15293 and Form 15603 are new forms, and new information collections, which results in an increase of burden of 150 hours and 600 respondents/responses.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/06/2024

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