Form 8937, Report of Organizational Actions Affecting Basis of Securities

Forms and Documents

Document Name	Status
Form 8937 Form 8937, Report of Organizational Actions Affecting Basis of Securities Form and Instruction	New
Expiration Explanation.rtf Supplementary Document	2011-07-12
Supporting Statement OMB FORM (8937).doc Supporting Statement A	2011-07-12

IC Document Collections

IC ID	Document Title	Status
198455	Form 8937, Report of Organizational Actions Affecting Basis of Securities Form and Instruction	New

ICR Details

OMB Control No: 1545-2224	ICR Reference No: 201107-1545-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-XXXX-003
Title: Form 8937, Report of Organizational Actions Affecting Basis of Securities
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/29/2011
	Date Received in OIRA: 11/21/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved
Responses	50,000	0	0
Time Burden (Hours)	206,500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Organizational actions that affect the basis of stock will be reported on this form. This form will be sent to stock holders of record and nominees affected.

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Authorizing Statute(s): US Code: 26 USC 6045B Name of Law: Returns relating to actions affecting basis of specified securities.
  

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:
	76 FR 23645	04/27/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 71621	11/18/2011
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
Form 8937, Report of Organizational Actions Affecting Basis of Securities	8937	Report of Organizational Actions Basis of Securities

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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	0	50,000	0	0
Annual Time Burden (Hours)	206,500	0	0	206,500	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new form. IRC section 6045B and Treasury regulations section 1.6045B-1 require the issuers of specified securities to report organizational actions that affect basis of those securities. This results in a burden increase of 206,500 hours.

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Annual Cost to Federal Government: $0

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: 11/21/2011

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