Exclusion of Income for Bona Fide Residents of American Samoa

ICR 200506-1545-023

OMB: 1545-0173

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1545-0173 200506-1545-023
Historical Active 200206-1545-011
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 08/10/2005
Retrieve Notice of Action (NOA) 06/16/2005
  Inventory as of this Action Requested Previously Approved
08/31/2008 08/31/2008 08/31/2005
100 0 100
174 0 174
0 0 0

Form 4563 is 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 IRS 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) 174 174 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.
06/16/2005


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