IRC CHAPTERS 41 AND 42 IMPOSE CERTAIN
EXCISE TAXES ON SPECIFIED TAX-EXEMPT ORGANIZATIONS, NON-EXEMPT
CHARITABLE TRUSTS AND CERTAIN RELATED INDIVIDUALS FOR ENGAGING IN
PRESCRIBED ACTIVITIES ENUMERATED IN THOSE CHAPTERS. THIS FORM IS
USED TO REPORT AND PAY THE INITIAL TAXES IMPOSED UNDER THOSE
CHAPTERS. THE DATA IS USED TO HELP VERIFY THAT THE ACTIVITIES HAVE
BEEN PROPERLY REPORTED AND THE CORRECT TAX PAID.
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:
(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;
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.