THE FORM IS USED IN DETERMINING
UNREPORTED INCOME FROM SAVINGS PLAN DISTRIBUTIONS. THIS FORM WILL
MATERIALLY INCREASE CONSISTENCY AND EXPEDIENCY IN DETERMINING THE
TAXABLE PORTION OF DISTRIBUTIONS MADE FR SAVINGS PLANS. PURSUANT TO
INTERNAL REVENUE CODE SECTION 402, THE AMOUNT ACTUALLY DISTRIBUTED
OR MADE AVAILABLE TO ANY DISTRIBUTEE SHALL BE TAXABLE TO HIM IN THE
YEAR IN WHICH DISTRIBUTED OR MADE AVAILABLE. THE FORM CAN BE
ADAPTED TO NUMEROUS PLANS.
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.