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###### Department of the Treasury

###### Internal Revenue Service

# AGENCY:

Internal Revenue Service (IRS), Treasury.

# ACTION:

Notice and request for comments.

# SUMMARY:

The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13(44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 4669, Statement of Payments Received.

# DATES:

Written comments should be received on or before March 16, 2015 to be assured of consideration.

# ADDRESSES:

Direct all written comments to Christie Preston, Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224.

# FOR FURTHER INFORMATION CONTACT:

                        Requests for additional information or copies of the form and instructions should be directed to Kerry Dennis at Internal Revenue Service, Room 129, 1111 Constitution Avenue NW., Washington DC 20224, or through the internet, at                         *Kerry.Dennis@irs.gov.*

# SUPPLEMENTARY INFORMATION:

*Title:*                     Statement of Payments Received.                

*OMB Number:*                     1545-XXXX.                

*Form Number:*                     4669.                

*Abstract:*                     Form 4669 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                           ( print page 2182)                        each payee for each year relief is requested.                

*Current Actions:*                     Request for new OMB Control Number.                

*Type of Review:*                     Existing collection in use without an OMB number.                

*Affected Public:*                     Business or other for-profit organizations.                

*Estimated Number of Respondents:*                     85,000.                

*Estimated Time per Response:*                     15 minutes.                

*Estimated Total Annual Burden Hours:*                     21,250.                

The following paragraph applies to all of the collections of information covered by this notice:

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103.

*Request for Comments:*                     Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All comments will become a matter of public record. Comments are invited on: (a) Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and (e) estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information.                

Approved: January 5, 2015.

Christie Preston,

IRS Reports Clearance Officer.

[FR Doc. 2015-00477 Filed 1-14-15; 8:45 am]

BILLING CODE 4830-01-P