Report of Employer-Owned Life Insurance Contracts

ICR 201107-1545-019

OMB: 1545-2089

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2008-03-24
Supporting Statement A
2011-08-31
IC Document Collections
ICR Details
1545-2089 201107-1545-019
Historical Active 200803-1545-007
TREAS/IRS ah-2089-019
Report of Employer-Owned Life Insurance Contracts
Extension without change of a currently approved collection   No
Regular
Approved without change 10/26/2011
Retrieve Notice of Action (NOA) 08/31/2011
  Inventory as of this Action Requested Previously Approved
10/31/2014 36 Months From Approved 10/31/2011
16,000 0 16,000
71,360 0 71,360
0 0 0

IRC 6039I requires every policyholder of employer-owned life insurance contracts to file a return showing the number of contracts owned, the total number of employees at the end of the year, the number of such employees insured, and that the policyholder has a valid consent for each insured employee. Form 8925 will be used to report this information.

PL: Pub.L. 109 - 280 120 Stat. 780 Name of Law: The Pension Protection Act
   US Code: 26 USC 6039 Name of Law: Information required in connection with certain options
   US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
  
None

Not associated with rulemaking

  76 FR 12417 03/07/2011
76 FR 53025 08/24/2011
No

1
IC Title Form No. Form Name
Report of Employer-Owned Life Insurance Contracts 8925 Report of Employer-Owned Life Insurance Contracts

  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 16,000 16,000 0 0 0 0
Annual Time Burden (Hours) 71,360 71,360 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$25,000
No
No
No
No
No
Uncollected
Barbara Bradley 2026223878

  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.
08/31/2011


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