Information Collection

Qualified Dividends Tax Worksheet

IC 191279 under ICR 201011-1545-014 · OMB 1545-0092.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0092 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1041_Inst_Qual Dividends Tax Wrksht.pdf	Other-Worksheet
2009 SchG line 1a burden.PDF burden	IC Document

IC Title:

Qualified Dividends Tax Worksheet

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Worksheet			1041_Inst_Qual Dividends Tax Wrksht.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	131,100	131,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
burden	2009 SchG line 1a burden.PDF	07/22/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.