Multiple Support Declaration

ICR 200210-1545-019

OMB: 1545-0071

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
16859 Migrated
ICR Details
1545-0071 200210-1545-019
Historical Active 200112-1545-050
TREAS/IRS
Multiple Support Declaration
Extension without change of a currently approved collection   No
Regular
Approved without change 11/25/2002
Retrieve Notice of Action (NOA) 10/21/2002
  Inventory as of this Action Requested Previously Approved
12/31/2005 12/31/2005 12/31/2002
11,000 0 11,000
5,830 0 5,830
0 0 0

A taxpayer who pays more than 10%, but less that 50%, of the support for an individual may claim that individual as a dependent provided the taxpayer attaches declarations from anyone else providing at least 10% support stating that they will not claim the dependent. This form is used to show that the other contributors have agreed not to claim the individual as a dependent.

None
None


No

1
IC Title Form No. Form Name
Multiple Support Declaration 2120

  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 11,000 11,000 0 0 0 0
Annual Time Burden (Hours) 5,830 5,830 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.
10/21/2002


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