U.S. Departing Alien Income Tax Return

Forms and Documents

Document Name	Status
Form 1040-C U.S. Departing Alien Income Tax Return Form	Modified
ombat1.doc Supplementary Document	2010-09-22
ss1040c[1].doc Supporting Statement A	2010-09-22

IC Document Collections

IC ID	Document Title	Status
16878	U.S. Departing Alien Income Tax Return Form	Modified

ICR Details

OMB Control No: 1545-0086	ICR Reference No: 201009-1545-047
Status: Historical Active	Previous ICR Reference No: 200902-1545-009
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: U.S. Departing Alien Income Tax Return
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/28/2011
	Date Received in OIRA: 11/30/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved	01/31/2011
Responses	2,000	0	2,500
Time Burden (Hours)	13,200	0	14,177
Cost Burden (Dollars)	0	0	0

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Abstract: Form 1040-C is used by aliens departing the U.S. to report income received or expected to be received for the entire tax year. The data collected are used to ensure that the departing alien has no outstanding U.S. tax liability.

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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 6851 Name of Law: Termination assessments of income tax
   PL: Pub.L. 110 - 343 871, 22, 702 Name of Law: Tax Extenders and Alternative Minimum Tax Relief Act of 2008 (Div. C)
   PL: Pub.L. 110 - 245 301 Name of Law: Earned Income Credit
   PL: Pub.L. 111 - 5 1001, 1003, 1007, 1008 Name of Law: American Recovery and Reivestment Act
  

Citations for New Statutory Requirements: US Code: 26 USC 68(g) Name of Law: Overall limitation on itemized deductions
US Code: 26 USC 151(d)(3)(F) Name of Law: Allowance of deductions for personal exemptions
US Code: 26 USC 219(b)(5) Name of Law: Retirement savings
US Code: 26 USC 55(d)(1) Name of Law: Alternative minimum tax imposed
US Code: 26 USC 199(a)(1) Name of Law: Income attributable to domestic production activities
US Code: 26 USC 25C(a) and (b) and 25(e)(1)(C) Name of Law: Interest on certain home mortgages
US Code: 26 USC 408A(d)(3)(A)(iii) and 408(d) Name of Law: Individual retirement accounts
US Code: 26 USC 30B(b)(1)((A) Name of Law: Alternative motor vehicle credit
US Code: 26 USC 36(f)(7) Name of Law: First-time homebuyer credit
US Code: 26 USC 85(c) Name of Law: Unemployment compensation

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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:
	75 FR 38178	07/01/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 71488	11/23/2010
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
U.S. Departing Alien Income Tax Return	1040-C	U.S. Departing Alien Income Tax Return

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ICR Summary 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	2,000	2,500	-500	0	0	0
Annual Time Burden (Hours)	13,200	14,177	-977	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: Form 1040-C is used by aliens departing the U.S. to report income received or expected to be received for the entire tax year. Form 1040-C was revised to incorporate changes due to tax law sunset and sunrise provisions and new legislation. At the time the form and instructions went to print, Congress was considering legislation that would extend some of these items. What’s New - • Personal exemption and itemized deduction phaseouts. For 2010, taxpayers with AGI above a certain amount will not lose part of their deduction for personal exemptions and itemized deductions. Under current law, these phaseouts will resume in 2011

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Annual Cost to Federal Government: $27,141

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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

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: 11/30/2010

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