Tax Check Waiver

Forms and Documents

Document Name	Status
Form 12339 Tax Check Waiver Form	Modified
Form 13775 Form 13775 - Tax Check Waiver Form	Modified
Non-Display Expiration Date Statement.docx Supplementary Document	2011-12-29
Supporting_Statement_DEC2011_REV.doc Supporting Statement A	2011-12-29

IC Document Collections

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

ICR Details

OMB Control No: 1545-1791	ICR Reference No: 201112-1545-022
Status: Historical Active	Previous ICR Reference No: 201103-1545-015
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Tax Check Waiver
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: 03/25/2012
	Date Received in OIRA: 12/29/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved	03/31/2012
Responses	550	0	550
Time Burden (Hours)	492	0	492
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:
	76 FR 40449	07/08/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 81557	12/28/2011
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, 12339-B, 12339-C	Internal Revenue Service Advisory Council Membership Application ,   Information Reporting Program Advisory Committee Membership Application ,   Advisory Committee on Tax Exempt and Government Entities Membership Application
Form 13775 - Tax Check Waiver	13775	Tax Check 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	550	0	0	0	0
Annual Time Burden (Hours)	492	492	0	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:

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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: 12/29/2011

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