LIFE INSURANCE STATEMENT

ICR 199406-1545-014

OMB: 1545-0022

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
127972 Migrated
ICR Details
1545-0022 199406-1545-014
Historical Active 199109-1545-013
TREAS/IRS
LIFE INSURANCE STATEMENT
Revision of a currently approved collection   No
Regular
Approved without change 09/03/1994
Retrieve Notice of Action (NOA) 06/30/1994
You may omit printing the expiration date on this form.
  Inventory as of this Action Requested Previously Approved
09/30/1997 09/30/1997 11/30/1994
60,000 0 55,000
1,122,600 0 1,029,050
0 0 0

FORM 712 IS USED TO ESTABLISH THE VALUE OF LIFE INSURANCE POLICIES FOR ESTATE AND GIFT TAX PURPOSES. THE TAX IS BASED ON THE VALUE OF THESE POLICIES. THE FORM IS COMPLETED BY LIFE INSURANCE COMPANIES.

None
None


No

1
IC Title Form No. Form Name
LIFE INSURANCE STATEMENT 712

  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 60,000 55,000 0 0 5,000 0
Annual Time Burden (Hours) 1,122,600 1,029,050 0 0 93,550 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
06/30/1994


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