You may omit
printing the expiration date on this form.
Inventory as of this Action
Requested
Previously Approved
09/30/1997
09/30/1997
10/31/1994
76,000
0
76,000
89,680
0
94,240
0
0
0
SECTION 3102 REQUIRES AN EMPLOYEE WHO
RECEIVES TIPS SUBJECT TO FICA TAX TO COMPUTE TAX DUE ON THESE TIPS
IF THE EMPLOYEE DID NOT REPORT THEM TO HIS OR HER EMPLOYER. THE
DATA IS USED TO HELP VERIFY THAT THE FICA TAX ON TIP INCOME IS
CORRECTLY COMPUTED.
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.