Approved with
the understanding that the box labeled "2nd TIN NOT," will not
appear on Copy B. You may omit printing the expiration date on this
form. Also, you may continue to use previous versions of this
form.
Inventory as of this Action
Requested
Previously Approved
08/31/1993
08/31/1993
10/31/1992
96,282,800
0
89,449,766
22,145,044
0
19,678,949
0
0
0
THE FORM IS USED BY THE SERVICE TO
INSURE THAT DIVIDENDS ARE PROPERLY REPORTED AS REQUIRED BY CODE
SECTION 6042 AND THAT LIQUIDATION DISTRIBUTIONS ARE CORRECTLY
REPORTED AS REQUIRED BY CODE SECTION 6043 AND TO DETERMINE WHETHER
PAYEES ARE CORRECTLY REPORTING THEIR INCOME.
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.