Form 14039-B - Business Identity Theft Affidavit

Identity Theft Affidavit and Business Identity Theft Affidavit

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2139 can be found here:

Documents and Forms

Document Name Document Type
Form Form 14039-B Form 14039-B - Business Identity Theft Affidavit Form and Instruction
Form 14039-B Business Identity Theft Affidavit Form 14039-B (Jan 2014 Rev).pdf Form and Instruction
Form 14039-B (SP) Declaracion Jurada sobre el Robo de Identidad de un Nego Form 14039-B(SP)(Jan 2014 Rev).pdf Form and Instruction
2018-Form_14039-B-Burden Special Business Calc.pdf 2018 burden form 14039-B IC Document

Information Collection (IC) Details

IC Title:	Form 14039-B - Business Identity Theft Affidavit	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Form 14039-B	Business Identity Theft Affidavit	Form 14039-B (Jan 2014 Rev).pdf		Yes	No	Fillable Printable
Form and Instruction	Form 14039-B (SP)	Declaracion Jurada sobre el Robo de Identidad de un Negocio	Form 14039-B(SP)(Jan 2014 Rev).pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: Treas/IRS 24.046 – CADE Business Master File	FR Citation: 80 FR 54064

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	20,000	0	20,000
Annual IC Time Burden (Hours)	6,200	1,200	5,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
2018 burden form 14039-B	2018-Form_14039-B-Burden Special Business Calc.pdf	02/06/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.