Information Collection

Form 14417-A - Statistics of Income - User Fee

IC 206240 under ICR 202511-1545-017 · OMB 1545-2235.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 14417-A Statistics of Income - User Fee Form 14417-A - Statistics of Income - User Fee	Form
14417-A Statistics of Income - User Fee Form 14417-A (Rev. 3-2023).pdf	Form

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	14417-A				Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-5	10
Annual IC Time Burden (Hours)	5	-5	10
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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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