COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX CREDIT

ICR 198409-1545-009

OMB: 1545-0171

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1545-0171 198409-1545-009
Historical Active 198307-1545-006
TREAS/IRS
COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX CREDIT
Revision of a currently approved collection   No
Regular
Approved without change 09/26/1984
Retrieve Notice of Action (NOA) 09/24/1984
  Inventory as of this Action Requested Previously Approved
09/30/1987 09/30/1987 07/31/1986
1,000 0 300,000
333 0 99,900
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 CREDIT 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 1,000 300,000 0 -299,000 0 0
Annual Time Burden (Hours) 333 99,900 0 -99,567 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
09/24/1984


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