Form 13614-T, Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 13614-T Form 13614-T, Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet	Form	New	Available
SSNFORM F 13614T OMB 2006-11-15.doc	Supporting Statement A	Uploaded 2006-11-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46046	Form 13614-T, Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet	Form	New

ICR Details

OMB Control No: 1545-2057	ICR Reference No: 200611-1545-025
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-XXXX-025
Title: Form 13614-T, Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/01/2006
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/09/2007
	Date Received in OIRA: 11/22/2006
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2007	6 Months From Approved
Responses	491,500	0	0
Time Burden (Hours)	81,917	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Form 13614-T, is part of a series of forms related to the Form 13614. The Form 13614-T will be used as the Intake Sheet for individuals who potentially qualify to file a Form 1040EZ-T, Request for Refund of Federal Telephone Excise Tax, to receive their refund.

Emergency Justfication: We request expedited processing because normal processing of this request will delay timely implementation and training of volunteers about how to use the form. It jeopardizes the IRS mission as follows: Our ability to provide top quality service will be significantly impacted. As cited previously in this statement, TIGTA states that an Intake Form, when correctly used, helps ensure volunteers collect and apply accurate tax data from a taxpayer so they pay the correct amount of tax, receive (if appropriate) the correct credits, and comply fully with their tax responsibilities. Integrity and fairness may be compromised. Without this form, more partners will need to create their own versions of the form which erodes consistent data collection. Because this form is critical to so many stakeholders at so many points in the volunteer return preparation process, it has been reviewed by many internal and external entities, who have or have had the opportunity to review, comment, and affect the ultimate version of the form including: „a AARP „a Armed Forces Tax Council „a Annie E. Casey Foundation „a National Community Tax Coalition „a TIGTA „a AICPA „a TAP „a An effective tool for understanding and solving problems from the taxpayers¡¦ point of view will be lost. This form, as described earlier, is the volunteers¡¦ guide for interviewing assisted taxpayers so they can understand a taxpayer¡¦s circumstances and prepare their return fully informed. This is the key to sensitively engaging assisted taxpayers at all levels. „a Volunteer¡¦s ability to foster open two-way communication with assisted taxpayers may be hindered. As shown previously in this statement, the purpose of this form is open a channel of communication between volunteers and assistors. Open responses from taxpayers on this form will most likely result in accurate tax return preparation by the volunteer. Timing Factors The final design of the Form 13614-T was delayed due to discussions being held Servicewide on the interpretation of the procedure for requesting a refund of the federal excise tax paid. Determining what information to collect on the Form was dependent upon decisions made regarding this process. The Form 13614-T is critical to continued improvements in the accuracy of volunteer-prepared returns.

---

Authorizing Statute(s): US Code: 26 USC 6103 Name of Law: null
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Form 13614-T, Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet	13614-T	Telephone Excise Tax Refund Form 1040EZ-T Intake Sheet

---

ICR Summary of Burden

table that charts list of burden

	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	491,500	0	0	491,500	0	0
Annual Time Burden (Hours)	81,917	0	0	81,917	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection.

---

Annual Cost to Federal Government: $8,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/22/2006

---