Life Insurance Statement

ICR 199706-1545-007

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
16754 Migrated
ICR Details
1545-0022 199706-1545-007
Historical Active 199406-1545-014
TREAS/IRS
Life Insurance Statement
Extension without change of a currently approved collection   No
Regular
Approved without change 07/25/1997
Retrieve Notice of Action (NOA) 06/20/1997
The agency is not required to display the expiration date.
  Inventory as of this Action Requested Previously Approved
07/31/2000 07/31/2000 09/30/1997
60,000 0 60,000
1,134,600 0 1,122,600
0 0 0

Form 172 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 compancies.

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 60,000 0 0 0 0
Annual Time Burden (Hours) 1,134,600 1,122,600 0 12,000 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.
06/20/1997


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