Form 8921 - Applicable Insurance Contracts Information Return

Forms and Documents

Document Name	Status
Form Form 8921 Applicable Insurance Contracts Information Return Form	New
F8921_brdn_busi.pdf Supplementary Document	2007-07-02
IRC Section 6050V.pdf Supplementary Document	2007-07-02
PPA Act section 1211.pdf Supplementary Document	2007-07-02
Notice_2007_24.pdf Supplementary Document	2007-07-02
f8921_Sup Stmnt.doc Supporting Statement A	2007-07-02

IC Document Collections

IC ID	Document Title	Status
181019	Applicable Insurance Contracts Information Return Form	New

ICR Details

OMB Control No: 1545-2083	ICR Reference No: 200707-1545-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No: CB-XXXX-001
Title: Form 8921 - Applicable Insurance Contracts Information Return
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/16/2007
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/16/2007
	Date Received in OIRA: 07/05/2007
Terms of Clearance: Per the agency's explanation, OMB has recategorized the program change as due to statute.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2008	6 Months From Approved
Responses	50,000	0	0
Time Burden (Hours)	1,794,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To comply with IRC section 6050V, as added by the Pension Protection Act of 2006, an applicable exempt organization must file a Form 8921 for each structured transaction under which it makes reportable acquisitions of applicable insurance contracts. The information gathered will be used by the Treasury to issue a two-year report to Congress.

Emergency Justfication: IRC section 6050V was added by Act section 1211 of the Pension Protection Act of 2006. The provision requires the Treasury Secretary to undertake a study on the use by tax-exempt organizations of applicable insurance contracts for the purpose of sharing the benefits of the organization's insurable interest in the insured individuals under such contracts with investors, and whether such activities are consistent with the tax-exempt status of the organizations. No later than 30 months after the date of enactment (August 17, 2006), the Treasury Secretary is required to report on the study to the Committee on Finance of the Senate and the Committee on Ways and Means of the House of Representatives. The Treasury must begin collecting this information immediately and the first due date for Form 8921 is November 1, 2007.

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Authorizing Statute(s): US Code: 26 USC 6050V Name of Law: Information and Returns
   US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 1211 Name of Law: Pension Protection Act of 2006

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Applicable Insurance Contracts Information Return	Form 8921	Applicable Insurance Contracts Information Return

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ICR Summary of Burden

	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	50,000	0	50,000	0	0	0
Annual Time Burden (Hours)	1,794,500	0	1,794,500	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Form 8921 is a new form with 141 line items and 8 code references.

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Annual Cost to Federal Government: $100

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/05/2007

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