Archer MSAs and Long-Term Care Insurance Contracts

ICR 200412-1545-030

OMB: 1545-1561

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
40894 Migrated
ICR Details
1545-1561 200412-1545-030
Historical Active 200409-1545-031
TREAS/IRS
Archer MSAs and Long-Term Care Insurance Contracts
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/03/2004
Retrieve Notice of Action (NOA) 12/03/2004
  Inventory as of this Action Requested Previously Approved
09/30/2006 09/30/2006 09/30/2006
73,500 0 73,500
96,645 0 92,395
0 0 0

This form is used by individuals to report general information about their medical savings accounts (MSAs), to figure their MSA deductions, and to figure their taxable distributions from MSAs. The form is also used to report taxable payments from long-term care (LTC) contracts.

None
None


No

1
IC Title Form No. Form Name
Archer MSAs and Long-Term Care Insurance Contracts 8853

  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 73,500 73,500 0 0 0 0
Annual Time Burden (Hours) 96,645 92,395 0 4,250 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.
12/03/2004


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