COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX

ICR 198208-1545-027

OMB: 1545-0171

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
129044 Migrated
ICR Details
1545-0171 198208-1545-027
Historical Active 198107-1545-024
TREAS/IRS
COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX
Revision of a currently approved collection   No
Regular
Approved without change 09/20/1982
Retrieve Notice of Action (NOA) 08/16/1982
  Inventory as of this Action Requested Previously Approved
08/31/1985 08/31/1985 12/31/1982
1,000 0 1,000
1,000 0 1,000
0 0 0

THE MAXIMUM HOSPITAL INSURANCE BENEFITS TAX THAT MAY BE IMPOSED ON AN EMPLOYEE IS SET BY LAW. FORM 4469 IS USED BY RAILROAD EMPLOYEE REPRESENTATIVES TO FIGURE THEIR REFUND OF EXCESS HOSPITAL INSURANCE BENEFITS TAX. THE INFORMATION COLLECTED IS USED TO VERIFY THE TAXPAYE IS ENTITLED TO THE CREDIT.

None
None


No

1
IC Title Form No. Form Name
COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX 4469

  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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 1,000 1,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
08/16/1982


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