Form 1040-SS, U.S. Self-Employment Tax Return; Form 1040-PR, Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,

Forms and Documents

Document Name	Status
Form Anexo H-PR Anejo H-PR, (Sch H); Contribuciones sobre el Empleo de Empleados Domesticos Form and Instruction	New
Form 1040-PR Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico Form	New
Form 1040-SS Form 1040-SS, U.S. Self-Employment Tax Return Form	Modified
Attachment to Supporting Statement.doc Supplementary Document	2008-07-21
Supporting Statement.doc Supporting Statement A	2008-07-21

IC Document Collections

IC ID	Document Title	Status
185781	Anejo H-PR, (Sch H); Contribuciones sobre el Empleo de Empleados Domesticos Form and Instruction	New
185780	Form 1040-PR, Instructions / Additional Child Tax Credit Worksheet Instruction	New
185776	Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico Form	New
185775	1040-SS Instructions / Additional Child Tax Credit Worksheet Instruction	New
16891	Form 1040-SS, U.S. Self-Employment Tax Return Form	Modified

ICR Details

OMB Control No: 1545-0090	ICR Reference No: 200807-1545-023
Status: Historical Active	Previous ICR Reference No: 200709-1545-003
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-0090-003
Title: Form 1040-SS, U.S. Self-Employment Tax Return; Form 1040-PR, Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/20/2008
	Date Received in OIRA: 10/03/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	36 Months From Approved	11/30/2008
Responses	430,400	0	430,400
Time Burden (Hours)	2,880,460	0	2,761,668
Cost Burden (Dollars)	0	0	0

---

Abstract: Form 1040-S (Virgin Islands, Guam, American Samoa, and the Northe Northern Mariana Islands) and 1040-PR (Puerto Rico) are used by self-employed individuals to figure and report self-employment tax under IRC chapter 2 of Subtitle A, and provide credit to the taxpayer's social security account. Anejo H-PR is used to compute household employment taxes. Form 1040-SS and Form 1040-PR are also used by bona-fide residents of Puerto Rico to claim the additional child tax credit.

---

Authorizing Statute(s): US Code: 26 USC 7651 Name of Law: Administration and collection of taxes and possessions.
   US Code: 26 USC 1401 Name of Law: Rate of tax.
   US Code: 26 USC 1402 Name of Law: Definitions
   US Code: 26 USC 6017 Name of Law: Self-employment tax returns.
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 432 Dic. C; sec 408 Name of Law: Tax Relief and Health Care Act of 2006

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 28857	05/19/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 57407	10/02/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
1040-SS Instructions / Additional Child Tax Credit Worksheet
Form 1040-SS, U.S. Self-Employment Tax Return	1040-SS	U.S Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)
Anejo H-PR, (Sch H); Contribuciones sobre el Empleo de Empleados Domesticos	Anexo H-PR	Contribuciones sobre el Empleo de Empleados Domesticos
Form 1040-PR, Instructions / Additional Child Tax Credit Worksheet
Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico	1040-PR	Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico

---

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	430,400	430,400	0	0	0	0
Annual Time Burden (Hours)	2,880,460	2,761,668	78,000	40,792	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: 1040-SS: On page 2, Part II, we added a caution statement under the heading per SE:W:CAR:MP:T:I:R. On page 2, Part III, we added text to the heading per SE:W:CAR:MP:T:I:R. On page 2, Part IV, we added text to the heading per SE:W:CAR:MP:T:I:R. On page 4, Part V, line 7, we increased the filled-in amount to $102,000 per Social Security Administration Announcement dated October 17, 2007. On page 4, Part V, line 8a, we increased the ceiling amount to $102,000 per Social Security Administration Announcement dated October 17, 2007. 1040-PR: 1. On page 2: • In Part II, we have added a “Precaución” (Caution) statement under the mast head cautioning filers that they must have three or more qualified children in order to claim the additional child tax credit. Per suggestion of SE:W:CAR:MP:T:I:R. • In Part III, we have added a reference to the Instructions for Schedule F (Form 1040), per suggestion of SE:W:CAR:MP:T:I:R. 2. On page 3, Part IV, we have added a reference to the Instructions for Schedule C (Form 1040), per suggestion of SE:W:CAR:MP:T:I:R. 3. On page 4, Part V, we have increased the amount of the Social security wage base to $102,000 in lines 7 and 8a per SSA Announcement dated October 17, 2007. Changes were a result of P.L. 109-432, Div C, sec. 408

---

Annual Cost to Federal Government: $261,673

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

---

Common Form ICR:  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:

(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: 10/03/2008

---