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Federal forms, ICRs, and supporting documents

Information Collection Request

Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit

ICR 201703-1545-020 · OMB 1545-2173 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form W-11 Form W-11 - Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit Form and Instruction Modified Available
2017-04-11 SS 1545-2173r.docx Supporting Statement A Uploaded 2017-04-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
192732 Form W-11 - Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit Form and Instruction Modified
ICR Details
1545-2173 201703-1545-020
Historical Active 201309-1545-073
TREAS/IRS
Hiring Incentives to Restore Employment (HIRE) Act Employee Affidavit
Extension without change of a currently approved collection   No
Regular
Approved without change 07/05/2017
Retrieve Notice of Action (NOA) 04/24/2017
  Inventory as of this Action Requested Previously Approved
07/31/2020 36 Months From Approved 07/31/2017
100,000 0 100,000
227,000 0 227,000
0 0 0
This form was created in response to the Hiring Incentives to Restore Employment (HIRE) Act, which was signed on March 18, 2010. The form was developed as a template for the convenience of employers who must collect affidavits from qualifying employees. The form is not filed, rather an employer must retain the affidavit in order to justify claiming certain HIRE Act benefits. A model form is needed as soon as possible so that employers can begin confidently claiming payroll exemptions.
PL: Pub.L. 111 - 147 101 Name of Law: Hiring Incentives to Restore Employment Act
  
None
Not associated with rulemaking
  82 FR 9482 02/06/2017
82 FR 18971 04/24/2017
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100,000 100,000 0 0 0 0
Annual Time Burden (Hours) 227,000 227,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$50,000
No
No
No
No
No
Uncollected
Pricilla Fritts 202 317-5747 [email protected]
  No
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.
04/24/2017