EMPLOYEE BENEFIT PLAN DECLARATION AND SIGNATURE FOR ELECTRONIC/MAGNETIC MEDIA FILING

ICR 199305-1545-012

OMB: 1545-1033

Federal Form Document

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ICR Details
1545-1033 199305-1545-012
Historical Active 199206-1545-015
TREAS/IRS
EMPLOYEE BENEFIT PLAN DECLARATION AND SIGNATURE FOR ELECTRONIC/MAGNETIC MEDIA FILING
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/18/1993
Approved with change 05/18/1993
Retrieve Notice of Action (NOA) 05/18/1993
  Inventory as of this Action Requested Previously Approved
09/30/1995 09/30/1995 09/30/1995
50,000 0 50,000
42,000 0 41,000
0 0 0

THIS FORM WILL BE USED TO SECURE TAXPAYER SIGNATURES AND DECLARATIONS CONJUNCTION WITH THE ELECTRONIC FILING OF FORM 5500 AND 5500-C. THIS FORM, TOGETHER WITH THE ELECTRONIC TRANSMISSIONS, WILL COMPRISE THE ANNUAL INFORMATION RETURN.

None
None


No

1
IC Title Form No. Form Name
EMPLOYEE BENEFIT PLAN DECLARATION AND SIGNATURE FOR ELECTRONIC/MAGNETIC MEDIA FILING 8453-E

  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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 42,000 41,000 0 1,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/18/1993


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