Form 1040-SS, U.S. Self-Employment Tax Return; Form 1040-PR, Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,

Forms and Documents

Document Name	Status
Form Form ANEXO H-PR (1 Anejo H-PR, (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos Form and Instruction	Modified
Form Form 1040-PR Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico Form	Modified
Form Form 1040-SS Form 1040-SS, U.S. Self-Employment Tax Return Form	Modified
Attachment to Supporting Statement.doc Supplementary Document	2008-07-21
Supporting Statement.doc Supporting Statement A	2011-11-07

IC Document Collections

IC ID	Document Title	Status
185781	Anejo H-PR, (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos Form and Instruction	Modified
185780	Form 1040-PR, Instructions / Additional Child Tax Credit Worksheet Instruction	Removed
185776	Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico Form	Modified
185775	1040-SS Instructions / Additional Child Tax Credit Worksheet Instruction	Removed
16891	Form 1040-SS, U.S. Self-Employment Tax Return Form	Modified

ICR Details

OMB Control No: 1545-0090	ICR Reference No: 201108-1545-024
Status: Historical Active	Previous ICR Reference No: 200807-1545-023
Agency/Subagency: TREAS/IRS	Agency Tracking No: EC-1545--0090-024
Title: Form 1040-SS, U.S. Self-Employment Tax Return; Form 1040-PR, Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,
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: 12/21/2011
	Date Received in OIRA: 11/30/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved	12/31/2011
Responses	246,860	0	430,400
Time Burden (Hours)	2,801,605	0	2,880,460
Cost Burden (Dollars)	0	0	0

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Abstract: Form 1040-S (Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands) and 1040-PR (Puerto Rico) are used by self-employed individuals to figure and report self-employment tax under IRC chapter 2 of Subtitle A, and provide credit to the taxpayer's social security account. Anejo H-PR is used to compute household employment taxes. Form 1040-SS and Form 1040-PR are also used by bona-fide residents of Puerto Rico to claim the additional child tax credit.

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Authorizing Statute(s): US Code: 26 USC 6017 Name of Law: Self-employment tax returns.
   US Code: 26 USC 7651 Name of Law: Administration and collection of taxes and possessions.
   US Code: 26 USC 1401 Name of Law: Rate of tax.
   US Code: 26 USC 1402 Name of Law: Definitions
  

Citations for New Statutory Requirements: None

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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:
	76 FR 34296	06/13/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 73017	11/28/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Form 1040-PR, Instructions / Additional Child Tax Credit Worksheet
Form 1040-SS, U.S. Self-Employment Tax Return	Form 1040-SS (2011 Draft), Form 1040-SS	U.S. Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico) ,   U.S. Self Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)
Anejo H-PR, (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos	Form ANEXO H-PR (1040 (SCH H) PR), 2011 Draft--Form ANEXO H-PR (1040 (SCH H) PR)	Contribuciones sobre el Empleo de Empleados Domesticos ,   Contribuciones sobre el Empleo de Empleados Domesticos
Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico	Form 1040-PR, Form 1040-PR (2011 Draft)	Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico ,   Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico
1040-SS Instructions / Additional Child Tax Credit Worksheet

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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	246,860	430,400	0	-186,000	2,460	0
Annual Time Burden (Hours)	2,801,605	2,880,460	0	-108,744	29,889	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes were made to form 1040-SS and 1-40-PR pursuant to Public Law 111-5, Div. B, sec 2202, Public Law 111-240, sec. 2042; Internal Revenue Code 162(I)(4). Changes were made to 1040-PR (Schedule H) per Public Law 111-226, section 219, HR 4853. Form 1040-SS Program Change Due to Agency Discretion: The burden for "additional Child Tax Credit Worksheet" is no longer being calculated separately. The number of lines and words for "Additional Child Tax Credit Worksheet" is already accounted for in the existing burden computation of the main forms. The estimated number of responses and the total annual burden remained the same. Form 1040-PR Program Change Due to Agency Estimate: Change Due to Adjustment in Agency Estimate resulted in an increase in the total number of responses by 2,460 and an increase in the total annual time burden hours by 29,889. Form 1040-PR (ANEXO H) Program Change Due to Agency Estimate: Changes to form 1040-PR (ANEXO H) resulted in a decrease in the total annual burden by 1, 584. Additional Child Tax Credit Worksheet Program Change Due to Agency Estimate: Eliminating a separate burden for "Additional Child Tax Credit Worksheet." decreased responses by 86,000 and decreased the total annual burden by 48,160.

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Annual Cost to Federal Government: $261,673

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]? Yes

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)? No

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: 11/30/2011

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