Information Collection Request

Identity Theft Affidavit and Business Identity Theft Affidavit

ICR 202508-1545-010 · OMB 1545-2139 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Form 14039-B Business Identity Theft Affidavit Form and Instruction Modified Available
Form Form 14039-B Form 14039-B - Business Identity Theft Affidavit Form and Instruction Modified Missing upstream
Form Form 14039 Identity Theft Affidavit Form and Instruction Modified Available
Form Form 14039 Form 14039 - Identity Theft Affidavit Form and Instruction Modified Repair queued
SUP STAT (1545-2139) final.docx Supporting Statement A Uploaded 2025-09-29 Available
SUP STAT (1545-2139) final.docx Supporting Statement A Uploaded 2025-09-29 Missing upstream

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
188502 Form 14039-B - Business Identity Theft Affidavit Form and Instruction ModifiedBusiness Identity Theft Affidavit
188502 Form 14039-B - Business Identity Theft Affidavit Form and Instruction Modified
188032 Form 14039 - Identity Theft Affidavit Form and Instruction ModifiedIdentity Theft Affidavit
188032 Form 14039 - Identity Theft Affidavit Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2029 36 Months From Approved 01/31/2026
347,785 0 369,501
834,315 0 885,302
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Form 14039 - Identity Theft Affidavit Form 14039
Form 14039-B - Business Identity Theft Affidavit Form 14039-B

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 347,785 369,501 0 0 -21,716 0
Annual Time Burden (Hours) 834,315 885,302 0 0 -50,987 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No