QUESTIONNAIRE - MEDICAL AND DENTAL EXPENSES

ICR 198301-1545-012

OMB: 1545-0335

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
129726 Migrated
ICR Details
1545-0335 198301-1545-012
Historical Active 198207-1545-010
TREAS/IRS
QUESTIONNAIRE - MEDICAL AND DENTAL EXPENSES
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 02/22/1983
Retrieve Notice of Action (NOA) 01/26/1983
  Inventory as of this Action Requested Previously Approved
08/31/1985 08/31/1985
125,000 0 0
62,500 0 0
0 0 0

FORM 4742 PROVIDES TAXPAYER WITH A SIMPLE FORMAT FOR PRESENTING INFORMATION NEEDED TO SUPPORT THEIR CLAIM FOR MEDICAL AND DENTAL EXPENSES UPON EXAMINATION. THIS INFORMATION IS USED TO DETERMINE WHETHER THE CLAIMED EXPENSES SHOULD BE ALLOWED.

None
None


No

1
IC Title Form No. Form Name
QUESTIONNAIRE - MEDICAL AND DENTAL EXPENSES 4742

  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 125,000 0 0 0 125,000 0
Annual Time Burden (Hours) 62,500 0 0 0 62,500 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.
01/26/1983


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