Form 14417 - Reimbursable Agreement - Non-Federal Entities; Form 14417-A - Statistics of Income - User Fee

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 14417-A Statistics of Income - User Fee	Form	Modified	Available
Form Form 14417 Reimbursable Agreement--Non-Federal Entities	Form and Instruction	Modified	Available
1545-2235 Supporting Statement 2026.docx	Supporting Statement A	Uploaded 2026-04-30	Available
p1075--2021-11-00.pdf	Supplementary Document	Uploaded 2025-12-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206240	Form 14417-A - Statistics of Income - User Fee	Form	Modified	Statistics of Income - User Fee
203932	Form 14417--Reimbursable Agreement - Non-Federal Entities	Form and Instruction	Modified	Reimbursable Agreement--Non-Federal Entities

ICR Details

OMB Control No: 1545-2235	ICR Reference No: 202511-1545-017
Status: Received in OIRA	Previous ICR Reference No: 202211-1545-013
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 14417 - Reimbursable Agreement - Non-Federal Entities; Form 14417-A - Statistics of Income - User Fee
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/30/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	05/31/2026
Responses	65	310
Time Burden (Hours)	35	160
Cost Burden (Dollars)	0	0

---

Abstract: Information collected with this form will be used by the Internal Revenue Service (IRS) to enter into cost reimbursable agreements with state, local, foreign government, and commercial entities. The authority to perform services on a cost reimbursable basis is contained in Section 6103(p) of the Internal Revenue Code. Performance of services is authorized when consistent with the basic public obligations of the IRS.

---

Authorizing Statute(s): US Code: 26 USC 7213A Name of Law: Unauthorized inspection of return or return information
   US Code: 26 USC 7213 Name of Law: Unauthorized disclosure return
   US Code: 26 USC 6108(b) Name of Law: Special Statistical Studies
   US Code: 26 USC 6103(p) Name of Law: Procedure and recordkeeping
   US Code: 26 USC 7431 Name of Law: Civil damages for unauthorized inspection or disclosure of returns and return information
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 59523	12/18/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22917	04/28/2026
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Form 14417--Reimbursable Agreement - Non-Federal Entities	Form 14417	Reimbursable Agreement--Non-Federal Entities
Form 14417-A - Statistics of Income - User Fee	14417-A	Statistics of Income - User Fee

---

ICR Summary of Burden

table that charts list of burden

	Total Request	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	65	310	0	0	-245	0
Annual Time Burden (Hours)	35	160	0	0	-125	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: Changes were made to the burden previously approved to update the estimated number of responses based on the most recent filing data. The annual number of responses requested is 65 (a decrease of 245 from the previously approved 310). No changes have been made to the form. The change in estimated responses results in an overall hourly burden decrease of 125 and current burden estimate is 35 hours as previously approved was 160 hours.

---

Annual Cost to Federal Government: $42,408

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.     No

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.     No

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

---

Common Form ICR:  No

---

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: 04/30/2026

---