FORM 5074 REFLECTS IRC SECTION 935 AND
REGULATIONS SECTION 301.7654-1 (D). USED AS AN ATTACHMENT FOR THE
U.S. FORM 1040 FILED BY A U.S. CITIZEN OR RESIDENT WHO REPORTS
ADJUSTED GROSS INCOME OF $50,000 OR MORE, WITH GROSS INCOME OF
$5,000 OR MORE FROM GUAM OR NORTHERN MARIANA ISLANDS SOURCES. THE
INFORMATION OBTAINED IS USED BY IRS FIGURE THE INCOME TAX DUE TO
GUAM OR NORTHERN MARIANA ISLANDS.
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.