Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

Forms and Documents

Document Name	Status
Form 990 Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form	Unchanged
Form Schedule R (F 990) Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form	Unchanged
Form Schedule N (Form 9 Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form	Unchanged
Form Schedule M (F 990) Schedule M - Non-Cash Contributions Form	Unchanged
Form Schedule L (Form 9 Schedule L - Transactions with Interested Persons Form	Unchanged
Form Schedule K (Form 9 Schedule K - Supplemental Information on Tax Exempt Bonds Form	Unchanged
Form Schedule J (F 990) Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form	Unchanged
Form Schedule I (Form 9 Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form	Unchanged
Form Schedule H (F 990) Schedule H - Hospitals Form	Unchanged
Form Schedule G (Form 9 Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form	Unchanged
Form Schedule F (Form 9 Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form	Unchanged
Form Schedule E (F 990) Schedule E - Schools Form	Unchanged
Form Schedule D (Form 9 Schedule D - Supplemental Financial Statements Form	Unchanged
Form 990 Sch. C Schedule C - Political Campaign and Lobbying Activities Form	Unchanged
Form Schedule B (Form 9 Schedule B - Schedule of Contributors Form and Instruction	Unchanged
Form Schedule A (Form 9 Schedule A - Public Charity Status and Public Support Form	Unchanged
IRS Schedule H letter (#3 final).pdf Supplementary Document	2012-05-15
990 sch. H (2010).pdf Supplementary Document	2012-05-15
Supporting Statement (6-20-12).doc Supporting Statement A	2012-06-25
Expiration Explanation.rtf Supplementary Document	2010-07-22

IC Document Collections

IC ID	Document Title	Status
39403	Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form	Unchanged
202829	REG-130266-11 (NPRM) Section 501(r)--Additional Requirements for Certain Hospitals	New
184772	Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form	Unchanged
184771	Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form	Unchanged
184770	Schedule M - Non-Cash Contributions Form	Unchanged
184769	Schedule L - Transactions with Interested Persons Form	Unchanged
184768	Schedule K - Supplemental Information on Tax Exempt Bonds Form	Unchanged
184767	Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form	Unchanged
184765	Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form	Unchanged
184764	Schedule H - Hospitals Form	Unchanged
184763	Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form	Unchanged
184762	Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form	Unchanged
184753	Schedule E - Schools Form	Unchanged
184752	Schedule D - Supplemental Financial Statements Form	Unchanged
184751	Schedule C - Political Campaign and Lobbying Activities Form	Unchanged
184750	Schedule B - Schedule of Contributors Form and Instruction	Unchanged
184749	Schedule A - Public Charity Status and Public Support Form	Unchanged

ICR Details

OMB Control No: 1545-0047	ICR Reference No: 201206-1545-013
Status: Historical Inactive	Previous ICR Reference No: 201205-1545-005
Agency/Subagency: TREAS/IRS	Agency Tracking No: EC-1545-0047-061
Title: Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 04/11/2013
	Date Received in OIRA: 06/26/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	04/30/2014
Responses	403,068	0	403,068
Time Burden (Hours)	25,766,156	0	25,766,156
Cost Burden (Dollars)	0	0	0

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Abstract: Form 990 is needed to determine that IRC section 501(a) tax-exempt organizations fulfill the operating conditions within the limitations of their tax exemption. REG-130266-11(NPRM) These regulations describe the requirements that charitable hospitals must satisfy under Section 501(r) of the Internal Revenue Code.

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Authorizing Statute(s): US Code: 26 USC 501 Name of Law: Exemption from tax on corporations, certain trusts, etc.
   US Code: 26 USC 527 Name of Law: Political organizations
   US Code: 26 USC 6033 Name of Law: Returns by exempt organizations
   US Code: 26 USC 4947 Name of Law: Application of taxes to certain nonexempt trusts
  

Citations for New Statutory Requirements: US Code: 26 USC 501(r) Name of Law: Additional Requirements for Certain Hospitals

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1545-BK57	Proposed rulemaking	77 FR 38147	06/26/2012

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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: 17

IC Title	Form No.	Form Name
Schedule C - Political Campaign and Lobbying Activities	990 Sch. C	Polical Campaign and Lobbying Activities
Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N	Schedule N-1, Schedule N (Form 990 or 990-EZ)	Liquidation, Termination, Dissolution or Significant Disposition of Assets ,   Continuation Sheet of Schedule N
Schedule H - Hospitals	Schedule H (F 990)	Hospitals
Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I	Schedule I (Form 990), Schedule I-I (Form 990)	Grants and Other Assistance to Organizations, Governments and Individuals in the U.S. ,   Continuation Sheet for Schedule I (Form 990)
Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F	Schedule F (Form 990), Schedule F-1 (Form 990)	Statement of Activities Outside the United States ,   Continuation Sheet for Schedule F
Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R	Schedule R (F 990), Schedule R-1 (F 990)	Related Organizations and Unrelated Partnerships ,   Continuation Sheet for Schedule R
Schedule K - Supplemental Information on Tax Exempt Bonds	Schedule K (Form 990)	Supplemental Information on Tax Exempt Bonds
Schedule L - Transactions with Interested Persons	Schedule L (Form 990 or 990-EZ)	Transactions with Interested Persons
Schedule M - Non-Cash Contributions	Schedule M (F 990)	Non-Cash Contribution
Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990	Schedule J (F 990), Schedule J-1 (F 990), Schedule J-2 (F 990)	Compensation Information ,   Continuation Sheet for Sch J ,   Continuation Sheet for Form 990
Schedule A - Public Charity Status and Public Support	Schedule A (Form 990 or 990EZ)	Public Charity Status and Public Support
Schedule B - Schedule of Contributors	Schedule B (Form 990)	Schedule of Contributors
Schedule E - Schools	Schedule E (F 990)	Schools
Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990	Schedule O, 990	Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ,   Supplemental Information to Form 990
Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities	Schedule G (Form 990 or 990-EZ)	Supplemental Information Regarding Fundraising or Gaming Activities
Schedule D - Supplemental Financial Statements	Schedule D (Form 990)	Supplemental Financial Statements
REG-130266-11 (NPRM) Section 501(r)--Additional Requirements for Certain Hospitals

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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: There is an increase in total burden hours due to requirements under The Affordable Care Act of 2010 as further described in the proposed regulations in §§1.501(r)-4 and 501(r)-6(c). The collection of information flows from section 501(r)(4) of the Internal Revenue Code (Code), which requires hospital organizations to establish a written financial assistance policy and a written policy related to care for emergency medical conditions, and section 501(r)(6), which requires a hospital organization to make reasonable efforts to determine whether an individual is eligible for assistance under a financial assistance policy before engaging in extraordinary collection actions against that individual. The expected recordkeepers are hospital organizations described in sections 501(c)(3) and 501(r)(2).

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Annual Cost to Federal Government: $20,000

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]? Yes

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: 06/26/2012

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