SUBSTITUTE FOR FORM W-2, WAGE AND TAX STATEMENT, OR FORM 1099R, DISTRIBUTIONS FROM PENSIONS, ANNUITIES, RETIREMENT, OR PROFIT-SHARING PLANS, IRA'S, INSURANCE CONTRACTS, ETC.
ICR 199304-1545-014 · OMB 1545-0458 · Historical Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1545-0458 can be found here:
SUBSTITUTE FOR FORM W-2, WAGE AND TAX STATEMENT, OR FORM 1099R, DISTRIBUTIONS FROM PENSIONS, ANNUITIES, RETIREMENT, OR PROFIT-SHARING PLANS, IRA'S, INSURANCE CONTRACTS, ETC.
IN THE ABSENCE OF A FORM W-2 OR 1099R FROM THE EMPLOYER OR PAYER, FORM 4852 IS USED BY THE TAXPAYER TO ESTIMATE GROSS WAGES, PENSIONS, ANNUITIES, RETIREMENT, OR IRA PAYMENTS RECEIVED AS WELL AS INCOME OR FICA TAX WITHHELD DURING THE YEAR. IT IS ATTACHED TO THE RETURN FOR PROCESSING.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
SUBSTITUTE FOR FORM W-2, WAGE AND TAX STATEMENT, OR FORM 1099R, DISTRIBUTIONS FROM PENSIONS, ANNUITIES, RETIREMENT, OR PROFIT-SHARING PLANS, IRA'S, INSURANCE CONTRACTS, ETC.