THIS
CERTIFICATION IS NOT SUBJECT TO THE PROVISIONS OF P.L. 96-511
BECAUSE IT DOES NOT REQUIRE THE CERTIFIER TO PROVIDE ANY
INFORMATION BEYOND CHECKING TWO BOXES AND IDENTIFYING HIM OR HER
SELF. THIS DETERMINATION IS BASED ON THE UNDERSTANDING THAT THE
WORKSHEET IS A FORM WHICH THE TAXPAYER NEED NOT COMPLETE AND RETAIN
OR PROVIDE TO ANOTHER PARTY.
Inventory as of this Action
Requested
Previously Approved
08/04/1981
12/31/1981
0
0
500
0
0
500
0
0
0
QUALIFIED EMPLOYEES CAN PREPARE AND
FILE THIS FORM WITH EMPLOYERS TO ELECT TO RECEIVE ADVANCE EARNED
INCOME CREDIT (EIC) PAYMENTS WITH THEI WAGES. THIS INFORMATION USED
TO DETERMINE THE AMOUNT OF THE ADVANCE EIC PAYMENTS TO BE
MADE.
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.