Information Collection

Form 14039 - Identity Theft Affidavit

IC 188032 under ICR 202508-1545-010 · OMB 1545-2139.

Documents and Forms

Document Name Document Type
Form Form 14039 Form 14039 - Identity Theft Affidavit Form and Instruction
Form Form 14039 Identity Theft Affidavit Form 14039 - Identity Theft Affidavit Form and Instruction
Form 14039 Identity Theft Affidavit f14039--2024-05-00.pdf Form and Instruction
Form 14039 Identity Theft Affidavit f14039--2024-05-00.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Form 14039 - Identity Theft Affidavit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 14039	Identity Theft Affidavit	f14039--2024-05-00.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: Treas/IRS 24.030 CADE Individual Master File (IMF)	FR Citation: 80 FR 54064

Number of Respondents: 344,094	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	344,094	-10,407	354,501
Annual IC Time Burden (Hours)	825,826	-24,976	850,802
Annual IC Cost Burden (Dollars)	0	0	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.

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