U.S. Individual Income Tax Return

Forms and Documents

Document Name	Status
Form Form 1040 EZ U.S. Individual Income Tax Return Form	Modified
IndividualTaxpayerComplianceBurdenTheRoleofAssistedMethodsinTaxpayerResponsetoIncreasingComplexity.pdf Supplementary Document	2017-10-30
Income-taxes-compliance-costs.pdf Supplementary Document	2017-10-30
BurdenSurvey.pdf Supplementary Document	2017-10-30
FY2012 ICB Burden Short Summary.doc Supplementary Document	2017-10-30
Supporting Statement_OIRA-0074-10-24-17r.docx Supporting Statement A	2017-10-25
ombat1.doc Supplementary Document	2009-02-20

IC Document Collections

IC ID	Document Title	Status
16870	U.S. Individual Income Tax Return Form	Modified

ICR Details

OMB Control No: 1545-0074	ICR Reference No: 201404-1545-014
Status: Historical Active	Previous ICR Reference No: 201404-1545-009
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: U.S. Individual Income Tax Return
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/30/2017
	Date Received in OIRA: 04/30/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	152,900,000	0	150,700,000
Time Burden (Hours)	1,855,000,000	0	2,647,000,000
Cost Burden (Dollars)	31,717,000,000	0	33,672,000,000

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Abstract: These forms and schedules are used by individuals to report their income tax liability. IRS uses the data collected on these forms and their schedules to compute tax liability and determine that the items claimed are properly allowable. This information is also used for general statistical purposes.

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Authorizing Statute(s): US Code: 26 USC 6039G Name of Law: Information on Individuals Losing United States Citizenship
   US Code: 26 USC 6031 Name of Law: Return of Partnership Income
   US Code: 26 USC 6038 Name of Law: Information Reporting with Respect to Certain Foreign Corporations and Partnerships
   US Code: 26 USC 6038B Name of Law: Notice of Certain Transfers to Foreign Persons
   US Code: 26 USC 6046A Name of Law: Returns as to Interest In Foreign Partnerships
   US Code: 26 USC 45E Name of Law: Small Employer Pension Plan Startup Costs
   US Code: 26 USC 45L Name of Law: New Energy Efficient Home Credit
   PL: Pub.L. 109 - 432 101 Name of Law: Tax Relief and Health Care Act of 2006
   US Code: 26 USC 631(a) Name of Law: Election to Consider Cutting as a Sale or Exchange
   US Code: 26 USC 631(b) Name of Law: Disposal of Timber
   US Code: 26 USC 6404 Name of Law: Abatements
   US Code: 26 USC 61 Name of Law: Gross Income Defined
   US Code: 26 USC 6511 Name of Law: Limitations on Credit or Refund
   US Code: 26 USC 222 Name of Law: Qualified Tuition and Related Expenses
   US Code: 26 USC 6402 Name of Law: Authority to Make Credits or Refunds
   US Code: 26 USC 68 Name of Law: Overall Limitation on Itemized Deducation
   PL: Pub.L. 91 - 508 609 Name of Law: The Fair Credit Reporting Act
   US Code: 26 USC 217 Name of Law: Moving Expenses
   US Code: 26 USC 1201 Name of Law: Alternative Tax for Corporations
   US Code: 26 USC 1202 Name of Law: Partial Exclusion for Gain from Certain Small Business Stock
   US Code: 26 USC 1211 Name of Law: Limitation on Capital Losses
   US Code: 26 USC 1212 Name of Law: Capital Loss Carrybacks and Carryovers
   US Code: 26 USC 1221 Name of Law: Capital Asset Defined
   US Code: 26 USC 1222 Name of Law: Other Terms Relating to Capital Gains and Losses
   US Code: 26 USC 1223 Name of Law: Holding Period of Property
   US Code: 26 USC 1231 Name of Law: Property Used in the Trade or Business and Involuntary Conversions
   US Code: 26 USC 6011 Name of Law: General Requirement of Return, Statement, or List
   US Code: 26 USC 6012 Name of Law: Persons Required to Make Returns of Income
   US Code: 26 USC 6096 Name of Law: Designation by Individuals
   US Code: 26 USC 6038B Name of Law: Notice of Certain Transfers or Foreign Presons
   US Code: 26 USC 367(e)(2) Name of Law: Liquidation under Section 332
   US Code: 26 USC 108(a) Name of Law: Exclusion from Gross Income
   US Code: 26 USC 67 Name of Law: Two Percent Floor on Miscellaneous Itemized Deductions
   US Code: 26 USC 163 Name of Law: Interest
   US Code: 26 USC 164 Name of Law: Taxes
   US Code: 26 USC 165 Name of Law: Losses
   US Code: 26 USC 170 Name of Law: Charitable, etc. Contributions and Gifts
   US Code: 26 USC 211 Name of Law: Allowance of Deductions
   US Code: 26 USC 212 Name of Law: Expenses for Production of Income
   US Code: 26 USC 213 Name of Law: Medical, Dental, etc. Expenses
   US Code: 26 USC 1233 Name of Law: Gains and Losses from Short Sales
   US Code: 26 USC 32 Name of Law: Earned Income
   US Code: 26 USC 3510 Name of Law: Coordination of Collection of Domestic Service Employment Taxes within Collection of Income Taxes
   US Code: 26 USC 1301 Name of Law: Averaging Farm Income
   US Code: 26 USC 1402 Name of Law: Definitions
   US Code: 26 USC 6411 Name of Law: Tenative Carryback and Refund Adjustments
   US Code: 26 USC 6654 Name of Law: Failure by Individual to Pay Estimated Income Tax
   US Code: 26 USC 179 Name of Law: Election to Expense Certain Depreciable Business Assets
   US Code: 26 USC 280F(b)(2) Name of Law: Recapture
   US Code: 26 USC 72 Name of Law: Annuities; Certain Proceeds of Endowment and Life Insurance Contracts
   US Code: 26 USC 6058 Name of Law: Information Required in Connection With Certain Plans of Deferred Compensation
   US Code: 26 USC 219 Name of Law: Retirement Savings
   US Code: 26 USC 408 Name of Law: Individual Retirement Accounts
   US Code: 26 USC 964(a) Name of Law: Earnings and Profits
   US Code: 26 USC 986(b) Name of Law: Earnings and Profits Distributions
   US Code: 26 USC 1256 Name of Law: Section 1256 Contracts Marked to Market
   US Code: 26 USC 1092 Name of Law: Straddles
   US Code: 26 USC 1298(b)(1) Name of Law: Time for Determination
   US Code: 26 USC 1291 Name of Law: Section 1291 Interest on Tax Deferral
   US Code: 26 USC 367(a) Name of Law: Transfers of Property from the United States
  

Citations for New Statutory Requirements: PL: Pub.L. 111 - 5 7000 Name of Law: American Recovery and Reinvestment Act of 2009
PL: Pub.L. 110 - 343 302 Name of Law: Emergency Economic Stabilization Act of 2008

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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:
	79 FR 11505	02/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 24498	04/30/2014
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
U.S. Individual Income Tax Return	Form 3903, Form 4070, Form 4070A, Form 1045, Form 8843, Form 8853, Schedule P (Form 8865), Form 8866, Form 8845, Form 8847, Form 8854, Form 8858, Form 8879 SP, Form T (Timber), Form 8896, Form 8931, Form 8888, Form 8900, Form SS-4, Form 1040 ES (PR), Form 8844, Schedule M (Form 8858), Form 8859, Form 8881, Form 8911, Form W-4, Form 8832, Form 8833, Form 8835, Form 8925, Form 8932, Form 8885, Form 8886, Form 8910, Form 8919, Form 8903, Form SS-8, Form W--4 P, Form 3520, Form 6252, Form 6478, Form 6765, Form 6781, Form 2210, Form 2210-F, Form 5754, Form 5884, Form 6198, Form 6251, Form 8275, Form 8275-R, Form 8582, Form 4563, Form 926, Schedule F (Form 1040), Schedule C-EZ (Form 1040), Schedule D (Form 1040), Schedule EIC (Form 1040), Form 2350, Form 2350 SP, Form 2439, Form 4137, Form 4136, Form 4255, Form 4797, Form 4852, Form 8822, Form 8828, Form 8834, Form 8840, Form 5695, Schedule O (Form 5471), Form 2106-EZ, Schedule J (Form 5471), Form 4361, Form 4562, Form 4835, Form 4972, Form 5405, Form 5471, Schedule M (Form 5471), Form 5713, Schedule A (Form 5713), Form 8606, Form 1040 A, Form 1040 EZ, Form 8898, 5884-B, W-7 (COA), Form 9465, Form 9465 SP, Form W-4 S, Form W-4 V, Form W-4 (SP), Form 8879, Form W-7, Form W-7 A, Form 1128, Form 8862, Form 8864, Form 8917, Form 8863, Form 8865, Form 8824, Form 1040 ES (NR), Form 8826, Form 8829, Form 8880, Form 8889, Form 8891, Form W-7 (SP), Form 8874, Form 8878 SP, 8912, Form 8878, Schedule K-1, Schedule O (Form 8865), Form 8873, Form 8907, Form 8846, Form 8812, Form 8818, Form 8820, Form 8821, Form 8332, Form 8621-A, Form 1040, Schedule E (Form 1040), Form 1040 ES, Form 4868 SP, Form 4952, Form 4970, Form 8283, Schedule SE (Form 1040), Form 1040 V, Form 2555 EZ, Form 2848, Schedule B (Form 1040), Schedule C (Form 1040), Form 1040 ES/OCR, Form 1127, Form 1310, Form 1040 NR, Form 8379, Form 8396, Form 8453, Form 8689, Form 970, Form 2555, Schedule H (Form 1040) and Sch H(PR), Schedule J (Form 1040), Schedule L (Form 1040), Schedule M (Form 1040), Schedule R (Form 1040), Form 673, Form 972, Form 982, Form 1116, Form 3468, Form 3800, Form 4684, Form 4868, Schedule B (Form 5713), Form 8908, Form 8936, Form 8814, Form 8815, Form 8082, Form 8582-CR, Form 8586, Form 8594, Form 8609-A, Form 8615, Form 8801, Form 8838, Form 8839, Form 8933, Form 8906, Form 8882, Form 8621, Form 8693, Form 2106, Form 2120, Form 2441, Form 1040 X, Form 1040 NR-EZ, Schedule A (1040), Form 5213, Schedule C (Form 5713), Form 5074, Form 3115, Form 5329, Form 4029, Form 8611, Form 8697	Income Tax Return for Single and Joint Filers with No Dependents ,   Amended U.S. Individual Income Tax Return ,   U.S. Nonresident Alien Income Tax Return ,   U.S. Income Tax Return for Certain Nonresident Aliens with No Dependents ,   Itemized Deductions ,   Interest and Ordinary Dividends ,   Profit or Loss from Business ,   Net Profit from Business ,   Capital Gains and Losses ,   Supplemental Income and Loss ,   Earned Income Credit ,   Profit or Loss from Farming ,   Household Employment Taxes ,   Income Averaging for Farmers and Fishermen ,   Standard Deduction for Certain Filers ,   Making Work Pay and Government Retiree Credits ,   Credit for the Elderly or the Disabled ,   Self-Employment Tax ,   Payment Voucher ,   Estimated Tax for Individuals (Optical Character Recognition with Form 1040V) ,   Estimate Tax for Individuals ,   Statement for Claiming Exemption from Withholding on Foreign Earned Income Eligible for the Exclusions Provided by Section 911 ,   Return by a U.S. Transferor of Property to a Foreign Corporation ,   Application to Use LIFO Inventory Method ,   Consent of Shareholder to Include Specific Amount in Gross Income ,   Reduction of Tax Attributes Due to Discharge of Indebtedness (and Section 1082 Basis Adjustment) ,   Application for Tentative Refund ,   Foreign Tax Credit ,   Application for Extension of Time for Payment of Tax ,   Application to Adpot, Change, or Retain a Tax Year ,   Statement of Person Claiming Refund Due to a Deceased Taxpayer ,   Employee Business Expenses ,   Unreimbursed Employee Business Expenses ,   Multiple Support Declaration ,   Underpayment of Estimated Tax by Individuals, Estates, and Trusts ,   Power of Attorney and Declaration of Representative ,   Application for Change in Accounting Method ,   Investment Credit ,   Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts ,   General Business Credit ,   Moving Expenses ,   Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits ,   Employee's Report of Tips to Employer ,   Employee's Daily Record of Tips ,   Credit for Federal Tax Paid on Fuels ,   Social Security and Medicare Tax on Undereported Tip Income ,   Recapture of Investment Credit ,   Application for Exemption From Self-Employment Tax for Use by Ministers, Members of Religious Orders, and Christian Science Practitioners ,   Depreciation and Amortization ,   Exclusion of Income for Bona Fide Residents of American Samoa ,   Casualities and Thefts ,   Sale of Business Property ,   Farm Rental Income and Expenses ,   Substitute for Form W-2, Wage and Tax Statement or Form 1099-R, Distributions From Pension Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc. ,   Application for Automatic Extension of Time fo Tile Individual U.S. Income Tax Return ,   Solicitud de Prorroga Automatica para Presentar la Declaracion del Impuesto sobre el Ingreso Personal de los Estados Unidos ,   Investment Interest Expense Deduction ,   Tax on Axxumulation Distribution of Trusts ,   Tax on Lump-Sum Distributions ,   Allocation of Individual Income Tax To Guam or the Commonwealth of the Northern Mariana Islands (CNMI) ,   Election to Postpone Determination as to Whether the Presumption Applies that an Activity is Engaged in for Profit ,   Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts ,   First-Time Homebuyer Credit ,   Information Return of U.S. Persons with Respect to Certain Foreign Corporations ,   Accumulated Earnings and Profits (E&P) and Taxes of Controlled Foreign Corporations ,   Transactions Between Controllwd Foreign Corporation and Shareholders or Other Related Persons ,   Organization or Reorganization of Foreign Corporation, and Acquisitions and Dispositions of its Stock ,   Residental Energy Credits ,   International Boycott Report ,   Internation Boycott Factor (Section 999(c)(1)) ,   Specifically Attributable Taxes and Income (Section 999(c)(2)) ,   Tax Effect of the Internationsl Boycott Provisions ,   Statement by Person(s) Receiving Gambling Winnings ,   Work Opportunity Cost ,   At-Risk Limitations ,   Underpayment of Estimated Tax by Farmers and Fishermen ,   Application for Extension of Time to File U.S. Income Tax Return ,   Solicitud de Prorroga para Presentar la Declaracion del Impuesto Personal sobre el Ingreso de lose Estados Unidos ,   Notice to Shareholder of Undistributed Long-Term Capital Gains ,   Child and Dependent Care Expenses ,   Foreign Earned Income ,   Foreign Earned Income Exclusion ,   Release of Claim to Exemption for Child of Divorced or Separated Parents ,   Injured Spouse Claim and Allocation ,   Mortgage Interest Credit ,   U.S. Individual Income Tax Declaration for an IRS e-file Return ,   Passive Activity Loss Limitation ,   Passive Activity Credit Limitations ,   Low-Income Housing Credit ,   Asset Acquisition Statement ,   Nondeductible IRAs ,   Annual Statement for Low-Income Housing Credit ,   Recapture of Low-Income Housing Credit ,   Tax for Certain Children Who Have Investment Income of More than $1,800 ,   Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund ,   Late Deemed Dividend or Deemed Sale Election by a Passive Foreign Investment Company ,   Allocation of Individual Income Tax to the Virgin Islands ,   Low-Income Housing Credit Disposition Bond ,   Alternative Minimum Tax-Individuals ,   Installment Sale Income ,   Credit for Alcohol Used as Fuel ,   Credit for Increasing Research Activities ,   Gains and Losses From Section 1256 Contracts and Straddles ,   Notice of Inconsistent Treatment or Administrative Adjustment Request (AAR) ,   Disclosure Statement ,   Regulation Disclosure Statement ,   Noncash Charitable Contributions ,   Interest Compnutations Under the Look-Back Method for Completed Long-Term Contracts ,   Credit for Prior Year Minimum Tax-Individuals, Estates, and Trusts ,   Additional Child Tax Credit ,   Parents' Election to Report Child's Interest and Dividends ,   Exclusion of Interest From Series EE and I U.S. Savings Bonds Issued After 1989 ,   Optional Form to Record Redemption of Series EE and I U.S. Savings Bonds Issued Aftern 1989 ,   Orphan Drug Credit ,   Tax Information Authorization ,   Change of Address ,   Like-Kind Exchanges ,   Disabled Access Credit ,   Recapture of Federal Mortgage Subsidy ,   Expenses for Business Use of Your Home ,   Entity Classification Election ,   Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b) ,   Qualified Electric Vehicle Credit ,   Renewable Electricity and Refined Coal Production Credit ,   Consent to Extend the Time to Assess Tax Under Section 367-Gain Recognition Statement ,   Qualified Adoption Expenses ,   Closer Connection Exception Statement for Aliens ,   Statement for Exempt Individuals and Individuals With a Medical Condition ,   Empowerment Zone and Renewal Community Employment Credit ,   Indian Employment Credit ,   Credit for Employer Social Security and Medicare Taxes Paid on Certain Employee tips ,   Credit for Contributions to Selected Community Development Corporations ,   Archer MSAa and Long-Term Care Insurance Contracts ,   Initial and Annual Expatriation Information Statement ,   Information Return of U.S. Persons With Respect to Foreign Disregarded Entities ,   Domestic Production Activities Deduction ,   Transactions Between controlled Foreign Disregarded Entity and Filer or Other Related Entities ,   Biodiesel Fuels Credit ,   New Markets Credit ,   District of Columbia First-Time Homebuyer Credit ,   Extraterritorial Income Exclusion ,   Return of U.S. Persons With Respect to Certain Foreign Partnerships ,   Partner's Share of Income Deductions, Credits, etc. ,   Transfer of Property to a Foreign Partnership ,   U.S. Individual Tax Return ,   U.S. Individual Income Tax Return ,   Acquisitions, Dispositions, and Changes of Interests in a Froeign Partnership ,   Interest Corporation Under the Look-Back Method for Property Depreciated Under the Income Forecast Method ,   Information to Claim Earned Income Credit After Disallowance ,   Education Credits ,   Alternative Fuel Vehicle Refueling Property Credit ,   Credit to Holders of Tax Credit Bonds ,   Tuition and Fees Deduction ,   Uncollected Social Security and Medicare Tax on Wages ,   Report of Employer-Owned Life Insurance Contracts ,   Agricultural Chemicals Security Credit ,   Credit for Employer Differential Wage Payments ,   Carbon Dioxide Sequestration Credit ,   Qualified Plug-In Electric Drive Motor Vehicle Credit ,   Installment Agreemenet Request ,   Solicitud para un Plan de Pagos a Plazos ,   Applicatin for Employer Identification Number ,   Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding ,   Forest Activities Schedules ,   Employee's Withholding Allowance Certificate ,   Withholding Certificate for Pension or Annuity Payments ,   Request for Federal Income Tax Withholding From Sick Pay ,   Voluntary Withholding Request ,   Certificado de Exencion de la Retencion del Empleado ,   Application for IRS Individual Taxpayger Indentification Number ,   Application for Taxpayer Identification Number for Pending U.S. Adoptions ,   Solicitud de Numero de Indenticacion Personal del Contribuyente del Servico de Impuestos Internos ,   U.S. Estimated Tax for Nonresident Alien Individuals ,   Federales Estimadas del Trabajo por Cuenta Propia y sobre el Impleo de Empleados Domestocs-Puerto Rico ,   Certificate of Accuracy for IRS Individual Taxpayer Identification Number ,   New Hire Retention Credit ,   IRS e-file Signature Authorization for Form 4686 or Form 2350 ,   Autorizacion de firma para presentar por medio del IRS e-file para el Formulario 4868 (SP) o el Formulario 2350 (SP) ,   IRS e-file Signature Authorization ,   Autorizacion de firm para presentar la Declaracion por medio del IRS e-file ,   Credit for Qualified Retirement Savings Contributions ,   Credit for Small Employer Pensions Plan Startup Costs ,   Credit for Employer-Provided Childcare Facilities and Services ,   Health Coverage Tax Credit ,   Reportable Transaction Discolsure Statement ,   Direct Deposit of Refund to More than One Account ,   Health Savings Accounts (HSAs) ,   Beneficiaries of Certain Canadian Registered Retirement Plans ,   Low Sulfur Diesel Fuel Production Credit ,   Statement for Individuals Who Begin or End Bona Fide Residence in a U.S. Possession ,   Qualified Railroad Track Maintenance Credit ,   Distills Spirits Credit ,   Nonconventional Source Fuel Credit ,   Energy Efficient Home Credit ,   Alternative Motor Vehicle Credit

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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	152,900,000	150,700,000	0	3,600,000	-1,400,000	0
Annual Time Burden (Hours)	1,855,000,000	2,647,000,000	8,000,000	-725,000,000	-75,000,000	0
Annual Cost Burden (Dollars)	31,717,000,000	33,672,000,000	352,000,000	-2,030,000,000	-277,000,000	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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: The change in estimated aggregate compliance burden can be explained by three major sources-technical adjustments, statutory changes, and discretionary agency (IRS) actions. Technical Adjustments- The largest adjustments are from incorporation of updated tax return data, macroeconomic data, and survey data as well as refinements in the estimation methodology. Updating the FY13 macroeconomic data and incorporating new tax return data lead to the largest technical adjustments. The impact of each technical adjustment can be seen below. Change in filers Change in time Change in dollars Updated FY13 Macroeconomic Data -3,100,000 -32,000,000 -762,000,000 Updated Tax Return Data 0 -53,000,000 -1,486,000,000 Updated Survey Data 0 6,000,000 1,063,000,000 FY14 Population Estimates 1,700,000 4,000,000 908,000,000 Statutory Changes- The primary drivers of the statutory changes are the phase-out of itemized deductions (American Taxpayer Relief Act of 2012), the Net Investment Income Tax (Health Care and Education Reconciliation Act of 2010), and the Additional Medicare Tax (Patient Protection and Affordable Care Act of 2010). The estimated impact of these items is as follows: Expected filers Change in hours Change in dollars Phase-out of Itemized Deductions 2,300,000 <500,000 $21,000,000 Net Investment Income Tax 2,800,000 4,000,000 202,000,000 Additional Medicare Tax 3,100,000 3,000,000 129,000,000 IRS Discretionary Changes- Introduction of the Office in the Home Safe Harbor impacts approximately 600,000 filers and decreases time by 1,600,000 hours (rounded to 2,000,000 hours) and money by $7,000,000. All other IRS discretionary changes had a negligible impact on taxpayer burden. Additional modifications were made to bring burden estimates current, as no changes to the burden estimates were made for the 2012 TY.

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Annual Cost to Federal Government: $15,000,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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)? Yes

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: 04/30/2014

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