Exclusion of Income for Bona Fide Residents of American Samoa

ICR 199607-1545-017

OMB: 1545-0173

Federal Form Document

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Document
Name
Status
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ICR Details
1545-0173 199607-1545-017
Historical Active 199308-1545-014
TREAS/IRS
Exclusion of Income for Bona Fide Residents of American Samoa
Extension without change of a currently approved collection   No
Regular
Approved without change 08/16/1996
Retrieve Notice of Action (NOA) 07/16/1996
The agency may omit the expiration date on the form.
  Inventory as of this Action Requested Previously Approved
08/31/1999 08/31/1999 11/30/1996
100 0 100
137 0 135
0 0 0

Used by bona fide residents of American Samoa whose income is from sources within American Samoa, Guam, and the Northern Mariana Islands to the extent specified in IRC section 931. This information is used by the Service to determine if an individual is eligible to exclude possession source income.

None
None


No

1
IC Title Form No. Form Name
Exclusion of Income for Bona Fide Residents of American Samoa 4563

  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 100 100 0 0 0 0
Annual Time Burden (Hours) 137 135 0 2 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.
07/16/1996


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