Your answers to
the OMB conditions of clearance dated December 3, 1991 are
accepted. 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
11/30/1995
11/30/1995
12/31/1992
5,000
0
5,000
1,250
0
1,250
0
0
0
THIS FORM WILL BE USED TO SECURE
TAXPAYER SIGNATURES AND DECLARATIONS IN CONJUNCTION WITH THE
MAGNETIC MEDIA FILING PROGRAM. THIS FORM, TOGETHER WITH THE
ELECTRONIC TRANSMISSION, WILL COMPRISE THE TAXPAYER'S INCOME TAX
RETURN.
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.