THIS FORM IS USED TO CLAIM ITEMIZED DEDUCTIONS (MEDICAL AND DENTAL INTEREST EXPENSES, CONTRIBUTIONS, CASUALTY OR THEFT LOSSES, AND MISCELLANEOUS DEDUCTIONS) PERMITTED UNDER IRC SECTIONS 163, 164, 165, 166, 211, 212, 213. THE DATA IS USED IN COMPUTING THE TAX LIABILITY, AND DETERMINING THAT THE ITEMS CLAIMED ARE PROPERLY ALLOWABLE AND ALSO FOR GENERAL STATISTICS USE.
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.