Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code

ICR 200911-1545-021

OMB: 1545-2148

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2009-11-25
IC Document Collections
ICR Details
1545-2148 200911-1545-021
Historical Active 200905-1545-024
TREAS/IRS
Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code
No material or nonsubstantive change to a currently approved collection   No
Emergency 06/05/2009
Approved without change 12/14/2009
Retrieve Notice of Action (NOA) 12/01/2009
  Inventory as of this Action Requested Previously Approved
12/31/2009 12/31/2009 12/31/2009
100 0 100
2,348 0 1,858
0 0 0

Form 8928 is used by employers, group health plans, HMOs, and third party administrators to report and pay excise taxes due for failures under sections 4980B, 4980D, 4980E, and 4980G.
Code sections 4980B, 4980D, 4980E, and 4980G provide for an excise tax for certain failures by employers, group health plans, HMOs, and third party administrators related to group health benefits. Form 8928 will be used to calculate and remit the amount of excise tax owed under these sections in compliance with the Code. We have been developing the form’s layout and its associated instructions with assistance from Chief Counsel. The instructions are in the final stages at this moment. An earlier request to OMB for Paperwork Reduction Act submission on the form and its instructions would have yielded incorrect results. As the form and instructions are needed for 2009, waiting the full 150 days for the process would hamper taxpayers from filing a timely tax return. A late availability of the form would not allow taxpayers to timely understand the new form and instructions. This would then place undue burden on both the taxpayer and the Service as extensions would have to be prepared by taxpayers and the Service would have to process them. Alternatively, the taxpayer could file their return on time and then have to file an amended return at a later date. This would also add undue taxpayer burden and burden the Service with additional processing costs for the second return.

PL: Pub.L. 104 - 191 402(a). Name of Law: Health Insurance Portability and Accountability Act of 1996
   PL: Pub.L. 100 - 647 3011(d). Name of Law: Technical Corrections Act of 1988
   PL: Pub.L. 108 - 173 1201(d)(4)(A). Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
   PL: Pub.L. 104 - 191 301(c)(4)(A). Name of Law: Health Insurance Portability and Accountability Act of 1996
  
PL: Pub.L. 108 - 173 1201(d)(4)(A). Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003

Not associated with rulemaking

No

  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) 2,348 1,858 0 490 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
Form 8928 is used by employers, group health plans, HMOs, and third party administrators to report and pay excise taxes due for failures under sections 4980B, 4980D, 4980E, and 4980G. Code sections 4980B, 4980D, 4980E, and 4980G provide for an excise tax for certain failures by employers, group health plans, HMOs, and third party administrators related to group health benefits. Form 8928 will be used to calculate and remit the amount of excise tax owed under these sections in compliance with the Code. The compliance with these Code sections results in an estimated increase in the burden hours by 490 hours.

$25,000
No
No
Uncollected
Uncollected
No
Uncollected
Jason Langley 2026224366

  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.
12/01/2009


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