2009 Addition of New Schedule R

PAPERWORK REDUCTION ACT SUBMISSION

Please read the Instructions before completing this form.

2. Agency : Department of Treasury, Internal Revenue Service

1. Type of IC Review:
New Form (Attach Supporting Statement)
Revision to Previously Approved IC (Attach Summary
of Changes)
Extension to previously approved IC (3-yr)
Reinstatement of previously approved IC
Existing IC in use that does not contain an OMB
control number
Deletion of currently approved IC

3. OMB Control No:

1 5 4 5 – 0 0 2 9

4. Type of Review:
Regular
Emergency * – Date Requested
By:
/
/
5. Small Entities: Will this ICR have a significant economic
impact on a substantial number of small entities?
Yes
No
7. Emergency Justification: Technical Authorization(TA):
(provide reference source)

6. Requested Expiration Date:
Three years from approval date
Other - Specify:
8. Emergency Justification Statement:

IC INFORMATION
9. Title: Allocation for Aggregate Form 941 Filers
10. Agency form number(s) (if applicable):
11. Authorizing Statute(s) for this IC:
US Code: 26
Public Law:
Statute at Large:
EO:

USC: 3504
Public Law:
Statute:
EO:

Schedule R (Form 941)
Acts to be performed by agents
Name of Law:
Name of Law:
Section:
Name of Law:
Name/Subject of EO:

12. Abstract:
The Service needs Schedule R (Form 941) to indentify the separate employers, their EIN's, and their allocated tax payments reported on an
aggregate Form 941, Employer' QUARTERLY Federal Tax Return and ensure income tax withholding and reporting compliance. The respondent is
the Agent who files the aggregate Form 941 on behalf of the employers that have completed Form 2678 to provide the Agent with such filing
authorization.

13. Affected Public: (Mark primary with “P” and all others that
apply with “X”)
Individuals or households
P Business or other for-profit
X Not-for-profit institutions

Farms
Federal Government
State, Local, or Tribal Gov’t

14. Annual Reporting and Recordkeeping burden hours:
a. Number of respondents . . . . . . . . .
b. Total annual responses . . . . . . . . .
1. Percentage of these responses
collected electronically . . . . . . . .
c.
d.
e.
f.

Total annual hours requested .
Current OMB inventory. . . . . .
Difference . . . . . . . . . . . . . .
Explanation of difference
1. Program change . . . . . . . .
2. Adjustment . . . . . . . . . . . .

6500
6500
22%

P Mandatory

Required to obtain or retain benefits

17. CFR citations: (Provide source(s) of change)
A.

CFR
CFR
CFR

B.
C.

18. Purpose of IC: (Mark primary with “P” and all others that
apply with “X”)

....
....

p

Ted Ronell,
Senior Policy Analyst
SB/SE Specialty, Employment Tax
15. Statistical Method: Does the ICR contain surveys,
censuses, or employ statistical methods?

Form 14029 (9-2008)

Voluntary

....
....
....

14a. Verification of estimated filers: (Provide source of
estimated filers)

Yes

16. Obligation to respond: (Mark primary with “P” and all
others that apply with “X”)

No

Catalog Number 51944B

Application for benefits
Program evaluation
General Purpose statistics
p Audit

Program planning or management
Research
Regulatory or compliance

19. Frequency of Recordkeeping or Reporting: (check all

that apply)
Recordkeeping
Reporting:
On occasion
Quarterly
Biennially

Third party disclosure
Weekly
Semi-annually
Other (describe)

Monthly
Annually

20. Agency Contact:
Name:

David DeCasseres

Phone:

202-927-4268

Department of the Treasury–Internal Revenue Service