Consumer Cooperative Exemption Application

OMB 1545-1941

A cooperative uses Form 3491 to apply for exemption from filing information returns (Forms 1099-PATR) on patronage distributions of $10 or more to any person during the calendar year.

The latest form for Consumer Cooperative Exemption Application expires 2021-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 3491 Consumer Cooperative Exemption Application Form and Instruction
SUP STAT (Form 3491) 1545-1941.docx Supporting Statement A
Consumer Cooperative Exemption Application Form and Instruction

All Historical Document Collections

202409-1545-012	Extension without change of a currently approved collection	2024-12-20
202105-1545-014 Approved without change	Extension without change of a currently approved collection	2021-10-29
201802-1545-008 Approved without change	Extension without change of a currently approved collection	2018-07-24
201501-1545-002 Approved without change	Extension without change of a currently approved collection	2015-03-31
201112-1545-021 Approved without change	Extension without change of a currently approved collection	2011-12-29
200810-1545-003 Approved without change	Extension without change of a currently approved collection	2008-11-14
200509-1545-008 Approved without change	Extension without change of a currently approved collection	2005-09-07
200504-1545-002 Approved without change	Existing collection in use without an OMB Control Number	2005-04-01