Supporting_Statement_for_Form_8934[1]

SUPPORTING STATEMENT
1. CIRCUMSTANCES NECESSITATING COLLECTION OF INFORMATION
New Proposed Treasury Regulations outline specific requirements that facilites have to meet when they
have mechanical dye injections systems. The Regulations are Section 48.4082-1. The safety standards require
automatic shut-off devices, safety seals, and other measures to see that the dye is injected properly in a safe
environment. It is new tax law that requires producing this new tax form to allow effected facilites to apply for the tax
exemption.

2. USE OF DATA
The data will be used by revenue agents, excise tax specialists and other IRS personnel working in the fuel
compliance area to evaluate if a facility meets the safety requriements. If the IRS finds the facility meets all the
requirements, it will be exempt from the excise tax on deisel fuel.

3. USE OF IMPROVED INFORMATION TECHNOLOGY TO REDUCE BURDEN
There are no plans to provide electronic filing because electronic filing is not appropriate for the collection of
information in this submission.

4. EFFORTS TO IDENTIFY DUPLICATION
We have attempted to eliminate duplication within the agency wherever possible.

5. METHODS TO MINIMIZE BURDEN ON SMALL BUSINESSES OR OTHER SMALL ENTITIES
Not applicable.

6. CONSEQUENCES OF LESS FREQUENT COLLECTION ON FEDERAL PROGRAMS OR
POLICY ACTIVITIES
Not applicable.

7. SPECIAL CIRCUMSTANCES REQUIRING DATA COLLECTION TO BE INCONSISTENT
WITH GUIDELINES IN 5 CFR 1320.5(d)(2)
Not applicable.

8. CONSULTATION WITH INDIVIDUALS OUTSIDE OF THE AGENCY ON AVAILABILITY
OF DATA, FREQUENCY OF COLLECTION, CLARITY OF INSTRUCTIONS AND FORMS,
AND DATA ELEMENTS
Periodic meetings are held between IRS personnel and representatives of various professional groups to discuss tax
law and tax forms. During these meetings, there is an opportunity for those attending to make comments regarding the
collection requirements under this form.
In response to the Federal Register Notice (74 FR 23240) dated May 18, 2009 we received no comments during the
comment period for this form.

9. EXPLANATION OF DECISION TO PROVIDE ANY PAYMENT OR GIFT TO RESPONDENTS
Not applicable.

10. ASSURANCE OF CONFIDENTIALITY OF RESPONSES
Generally, tax returns and tax return information are confidential as required by 26 U.S.C. 6103.

11. JUSTIFICATION OF SENSITIVE QUESTIONS
Not applicable.

12. ESTIMATED BURDEN OF INFORMATION COLLECTION
The burden estimate is as follows:

Form

8934

Number of
Responses
50

Time per
Response

Total
Hours

7 hr., 40 min.

383

13. ESTIMATED TOTAL ANNUAL COST BURDEN TO RESPONDENTS
As suggested by OMB, our Federal Register notice dated May 18 2009, (74 FR 23240) requested public comments on
estimates of cost burden that are not captured in the estimates of burden hours, i.e., estimates of capital or start-up
costs and costs of operation, maintenance, and purchase of services to provide information. However, we did not
receive any response from taxpayers on this subject. As a result, estimates of the cost burdens are not available at this
time.

14. ESTIMATED ANNUALIZED COST TO THE FEDERAL GOVERNMENT
Not applicable.

15. REASONS FOR CHANGE IN BURDEN
Not applicable.

16. PLANS FOR TABULATION, STATISTICAL ANALYSIS AND PUBLICATION
Not applicable.

17. REASONS WHY DISPLAYING THE OMB EXPIRATION DATE IS INAPPROPRIATE
See attached.

18. EXCEPTIONS TO THE CERTIFICATION STATEMENT ON OMB PRA SUBMISSION FORM
Not applicable.
Note: The following paragraph applies to all of the collections of information in this submission:
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless
the collection of information displays a valid OMB control number. Books or records relating to a collection of
information must be retained as long as their contents may become material in the administration of any internal
revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103.

19. REASON FOR EMERGENCY SUBMISSION