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 Regulations section 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. The collection of data affects business, individuals, and households.
The latest form for Statement of Payments Received expires 2023-08-31 and can be found here.
Document Name |
---|
Form and Instruction |
Supporting Statement A |
Approved without change |
Extension without change of a currently approved collection | 2023-08-30 | |
Approved with change |
Extension without change of a currently approved collection | 2019-08-28 | |
Approved without change |
Reinstatement with change of a previously approved collection | 2016-05-17 | |
Approved without change |
Extension without change of a currently approved collection | 1983-03-30 | |
Approved without change |
New collection (Request for a new OMB Control Number) | 1981-08-26 |