Form 8921 - Applicable Insurance Contracts Information Return

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 8921 Applicable Insurance Contracts Information Return	Form	Modified	Available
F8921_brdn_busi.pdf	Supplementary Document	Uploaded 2007-11-14	Available
IRC Section 6050V.pdf	Supplementary Document	Uploaded 2007-07-02	Available
PPA Act section 1211.pdf	Supplementary Document	Uploaded 2007-07-02	Available
Notice_2007_24.pdf	Supplementary Document	Uploaded 2007-07-02	Available
f8921_Sup Stmnt2.doc	Supporting Statement A	Uploaded 2007-11-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181019	Applicable Insurance Contracts Information Return	Form	Modified	Applicable Insurance Contracts Information Return
181019	Applicable Insurance Contracts Information Return	Instruction	Modified

ICR Details

OMB Control No: 1545-2083	ICR Reference No: 200711-1545-012
Status: Historical Active	Previous ICR Reference No: 200707-1545-001
Agency/Subagency: TREAS/IRS	Agency Tracking No: CB-2083-012
Title: Form 8921 - Applicable Insurance Contracts Information Return
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/18/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/22/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	04/30/2008
Responses	50,000	0	50,000
Time Burden (Hours)	1,794,500	0	1,794,500
Cost Burden (Dollars)	0	0	0

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Abstract: To comply with IRC section 6050V, as added by the Pension Protection Act of 2006, an applicable exempt organization must file a Form 8921 for each structured transaction under which it makes reportable acquisitions of applicable insurance contracts. The information gathered will be used by the Treasury to issue a two-year report to Congress.

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Authorizing Statute(s): US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
   US Code: 26 USC 6050V Name of Law: Information and Returns
  

Citations for New Statutory Requirements: PL: Pub.L. 109 - 280 1211 Name of Law: Pension Protection Act of 2006

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 51905	09/11/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 9855	02/22/2008
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Applicable Insurance Contracts Information Return	Form 8921	Applicable Insurance Contracts Information Return

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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	50,000	50,000	0	0	0	0
Annual Time Burden (Hours)	1,794,500	1,794,500	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $100

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

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Common Form ICR:  No

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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: 02/22/2008

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