Remarks added,
effective 07/21/94: Your ICW dated 07/15/94 is approved You may
omit printing the expiration date on this form.
Inventory as of this Action
Requested
Previously Approved
09/30/1996
09/30/1996
10/31/1993
50
0
50
202
0
202
0
0
0
USED BY U.S. CITIZENS OR RESIDENTS AS
AN ATTACHMENT TO FORM 1040 WHEN THEY HAVE $50,000 INCOME FROM U.S.
SOURCES AND $5,000 FROM GUAM OR NORTHERN MARIAN ISLANDS. THE DATA
IS USED BY IRS TO ALLOCATE INCOME TAX DUE TO GUAM OR NMI AS
REQUIRED BY 26 U.S.C. 7654
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.