Tax Check Waiver

Forms and Documents

Document Name	Status
Form 12339-A Tax Check Waiver Form	Unchanged
Form 13775 Form 13775 - Tax Check Waiver Form	New
Summary of Changes.pdf Justification for No Material/Nonsubstantive Change	2010-09-22

IC Document Collections

IC ID	Document Title	Status
41119	Tax Check Waiver Form	Unchanged
194648	Form 13775 - Tax Check Waiver Form	New

ICR Details

OMB Control No: 1545-1791	ICR Reference No: 201009-1545-048
Status: Historical Active	Previous ICR Reference No: 200810-1545-007
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Tax Check Waiver
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/23/2010
	Date Received in OIRA: 11/23/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	12/31/2011	12/31/2011
Responses	550	0	500
Time Burden (Hours)	492	0	417
Cost Burden (Dollars)	0	0	0

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Abstract: The tax check waiver is necessary for the purpose of ensuring that all panel members are tax compliant. Information provided will be used to qualify or disqualify individuals to serve as panel members. The information will be used as appropriate by the Taxpayer Advocate service staff, and other appropriate IRS personnel.

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Authorizing Statute(s): PL: Pub.L. 92 - 463 1 Name of Law: Federal Advisory Committee Act
  

Citations for New Statutory Requirements: None

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 42654	07/22/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 67573	11/14/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Tax Check Waiver	12339-A, 12339, 12339-B	Tax Check Waiver ,   Internal Revenue Service Advisory Council Membership Application ,   Information Reporting Program Advisory Committee Membership Application
Form 13775 - Tax Check Waiver	13775	TaxCheck Waiver

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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	550	500	0	0	50	0
Annual Time Burden (Hours)	492	417	0	0	75	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 12339 and Form 12339-B were created to better solicit and maintain all of the applicant information for those interested in becoming members of these Advisory Councils. Each form is submitted in conjunction with Form 12339-A. Form 13775 is used by Electronic Tax Administration Advisory Committee (ETAAC) applicants applying for membership and/or annual tax checks for current members. Form 13775 was created to better solicit and maintain all of the applicant information for those interested in becoming members of the ETA Advisory Council. Form 13775 must be completed by those individuals interested in applying for ETAAC. The creation of this new form results in an additional 75 hours to the total burden.

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Annual Cost to Federal Government: $500

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 11/23/2010

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