You may omit
printing the expiration date on this form. You may continue to use
prior versions of this from.
Inventory as of this Action
Requested
Previously Approved
09/30/1997
09/30/1997
09/30/1996
140,000
0
140,000
421,400
0
467,600
0
0
0
IRC SECTION 402(E) ALLOWS TAXPAYERS TO
COMPUTE A SEPARATE TAX ON A LUMP-SUM DISTRIBUTION FROM A QUALIFIED
RETIREMENT PLAN. FORM 4972 IS USED TO CORRECTLY FIGURE THAT TAX.
THE DATA IS USED TO VERIFY CORRECTNESS OF THE SEPARATE TAX. FORM
4972 IS ALSO USED TO MAKE THE SPECIAL 20 PERCENT CAPITAL GAIN
ELECTION ATTRIBUTABLE TO PRE-1974 PARTICIPATION FROM THE LUMP-SUM
DISTRIBUTION.
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.