Submission for OMB Review; Comment Request

---
identifier: "/us/fr/2015-23998"
source: "fr"
legal_status: "authoritative_unofficial"
title: "Submission for OMB Review; Comment Request"
title_number: 0
title_name: "Federal Register"
section_number: "2015-23998"
section_name: "Submission for OMB Review; Comment Request"
positive_law: false
currency: "2015-09-22"
last_updated: "2015-09-22"
format_version: "1.1.0"
generator: "[email protected]"
agency: "Treasury Department"
document_number: "2015-23998"
document_type: "notice"
publication_date: "2015-09-22"
agencies:
  - "Treasury Department"
fr_citation: "80 FR 57268"
fr_volume: 80
comments_close_date: "2015-10-22"
fr_action: "Notice."
---


#  Submission for OMB Review; Comment Request

**AGENCY:**

Department of the Treasury.

**ACTION:**

Notice.

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  (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 § 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.