Employee Benefit Plan Declaration and Signature for

ICR 200104-1545-045

OMB: 1545-1033

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
40002 Migrated
ICR Details
1545-1033 200104-1545-045
Historical Active 199807-1545-016
TREAS/IRS
Employee Benefit Plan Declaration and Signature for
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/10/2001
Retrieve Notice of Action (NOA) 04/10/2001
  Inventory as of this Action Requested Previously Approved
04/30/2001 04/30/2001 09/30/2001
50,000 0 50,000
45,500 0 45,500
0 0 0

This form will be used to secure taxpayer signatures and declarations in conjunction with the electronic filing of forms 5500, 5500-C/R, and 5500EZ. These forms, together with the electronic transmission, will comprise the annual information returns.

None
None


No

1
IC Title Form No. Form Name
Employee Benefit Plan Declaration and Signature for 8453-E

  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 50,000 50,000 0 0 0 0
Annual Time Burden (Hours) 45,500 45,500 0 0 0 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.
04/10/2001


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