Supporting_Statement(4219)

SUPPORTING STATEMENT
1. CIRCUMSTANCES NECESSITATING COLLECTION OF INFORMATION
Third parties who directly pay another's payrolls can be held liable for the full amount of taxes required to be withheld
but not paid to the Government (subject to the 25% limitation). IRC 3505 deals with persons who supply funds to an
employer for the purpose of paying wages. The notification that a third party is paying or supplying wages will usually
be made by filing of the Form 4219, Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes.
The Form 4219, Statement of Liability of Lender, Surety, or Other Person for Withholding Taxes is to be submitted and
associated with each employer and for every calendar quarter for which a liability under section 3505 is incurred.

2. USE OF DATA
The Form 4219 may be received from the third party or taxpayer and subsequently associated with the applicable
quarterly filed Form 941 to either confirm payment or nonpayment of the tax liability. If full payment of tax is not
received, the Form 4219 can be used to assist with the necessary investigation and potential initiation of a suit against
the third party for tax collection under Section 3505 within ten years after the assessment of the tax against the
employer.

3. USE OF IMPROVED INFORMATION TECHNOLOGY TO REDUCE BURDEN
We have no plans at this time to offer electronic filing because of the low volume compared to the cost of electronic
enabling.

4. EFFORTS TO IDENTIFY DUPLICATION
We have attempted to eliminate duplication within the agency wherever possible.

5. METHODS TO MINIMIZE BURDEN ON SMALL BUSINESSES OR OTHER SMALL ENTITIES
Not applicable.

6. CONSEQUENCES OF LESS FREQUENT COLLECTION ON FEDERAL PROGRAMS OR
POLICY ACTIVITIES
Not applicable.

Form 14029 (Rev. 4-2009) Catalog Number 51944B Page 4

Department of the Treasury–Internal Revenue Service

7. SPECIAL CIRCUMSTANCES REQUIRING DATA COLLECTION TO BE INCONSISTENT
WITH GUIDELINES IN 5 CFR 1320.5(d)(2)
Not applicable.

8. CONSULTATION WITH INDIVIDUALS OUTSIDE OF THE AGENCY ON AVAILABILITY
OF DATA, FREQUENCY OF COLLECTION, CLARITY OF INSTRUCTIONS AND FORMS,
AND DATA ELEMENTS
Periodic meetings are held between IRS personnel and representatives of various professional groups to discuss tax
law and tax forms. During these meetings, there is an opportunity for those attending to make comments regarding the
collection requirements under this form.
We will publish a notice in the Federal Register in the near future to solicit public comments on Form 4219.

9. EXPLANATION OF DECISION TO PROVIDE ANY PAYMENT OR GIFT TO RESPONDENTS
Not applicable.

10. ASSURANCE OF CONFIDENTIALITY OF RESPONSES
Generally, tax returns and tax return information are confidential as required by 26 USC 6103.

11. JUSTIFICATION OF SENSITIVE QUESTIONS
No personally identifiable informaton (PII) is collected.

12. ESTIMATED BURDEN OF INFORMATION COLLECTION
Number of
Responses
Form 4219

1,000

Time per
Response

Total
Hours

12.8333 hours

12,833

Estimates of the annualized cost to respondents for the hour burdens shown are not available at this time.

Form 14029 (Rev. 4-2009) Catalog Number 51944B

Page 5

Department of the Treasury–Internal Revenue Service

13. ESTIMATED TOTAL ANNUAL COST BURDEN TO RESPONDENTS
Estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide
information are not available at this time.

14. ESTIMATED ANNUALIZED COST TO THE FEDERAL GOVERNMENT
After consultation with various functions within the Service, we have determined that the cost of developing,
printing, processing, distribution and overhead for the form is $5,000.

15. REASONS FOR CHANGE IN BURDEN
This is a form previously used without an OMB approval number.

16. PLANS FOR TABULATION, STATISTICAL ANALYSIS AND PUBLICATION
Not applicable.

17. REASONS WHY DISPLAYING THE OMB EXPIRATION DATE IS INAPPROPRIATE
See attached.

18. EXCEPTIONS TO THE CERTIFICATION STATEMENT ON OMB PRA SUBMISSION FORM
Not applicable.
Note: The following paragraph applies to all of the collections of information in this submission:
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
the collection of information displays a valid OMB control number. Books or records relating to a collection of
information must be retained as long as their contents may become material in the administration of any internal
revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103.

19. REASON FOR EMERGENCY SUBMISSION
We are requesting emergency approval to bring into compliance Form 4219 with PRA requirements. Failure to make
this form available for use will prevent taxpayers from reporting and receiving credit for payroll wages paid by a third
party. Failure to have Form 4219 available to IRS will also complicate proper recordation of such payments which
could lead to inappropriate tax levies or audit actions.

Form 14029 (Rev. 4-2009) Catalog Number 51944B

Page 6

Department of the Treasury–Internal Revenue Service