[Federal Register Volume 80, Number 183 (Tuesday, September 22, 2015)]
[Notices]
[Pages 57268-57269]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-23998]


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DEPARTMENT OF THE TREASURY


Submission for OMB Review; Comment Request

AGENCY: Department of the Treasury.

ACTION: Notice.

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    The Department of the Treasury will submit the following 
information collection request to the Office of Management and Budget 
(OMB) for review and clearance in accordance with the Paperwork 
Reduction Act of 1995, Public Law 104-13, on or after the date of 
publication of this notice.

DATES: Comments should be received on or before October 22, 2015 to be 
assured of consideration.

ADDRESSES: Send comments regarding the burden estimate, or any other 
aspect of the information collection, including suggestions for 
reducing the burden, to

[[Page 57269]]

(1) Office of Information and Regulatory Affairs, Office of Management 
and Budget, Attention: Desk Officer for Treasury, New Executive Office 
Building, Room 10235, Washington, DC 20503, or email at 
[email protected] and (2) Treasury PRA Clearance Officer, 
1750 Pennsylvania Ave. NW., Suite 8140, Washington, DC 20220, or email 
at [email protected].

FOR FURTHER INFORMATION CONTACT: Copies of the submission(s) may be 
obtained by email at [email protected] or the entire information 
collection request may be found at www.reginfo.gov.

SUPPLEMENTARY INFORMATION:

Internal Revenue Service (IRS)

    OMB Number: 1545-0364.
    Type of Review: Reinstatement with change of a previously approved 
collection.
    Title: Statement of Payments Received.
    Form: 4669.
    Abstract: Form 4669, Statement of Payments Received, is used by 
payors in specific situations to request relief from payment of certain 
required taxes. A payor who fails to withhold certain required taxes 
from a payee may be entitled to relief, under sections 3402(d), 
3102(f)(3), 1463 or Sec.  1.1474-4. To apply for relief, a payor must 
show that the payee reported the payments and paid the corresponding 
tax. To secure relief as described above, a payor must obtain a 
separate, completed Form 4669 from each payee for each year relief is 
requested. The data is used to verify that the income tax on the wages 
was paid in full.
    Affected Public: Businesses or other for-profits.
    Estimated Annual Burden Hours: 21,250.

    Dated: September 17, 2015.
Dawn D. Wolfgang,
Treasury PRA Clearance Officer.
[FR Doc. 2015-23998 Filed 9-21-15; 8:45 am]
BILLING CODE 4830-01-P