Information Collection

Form 6069, Return of Excise Tax on Excess Contributions to Black Lung.......

IC 184974 under ICR 201109-1545-019 · OMB 1545-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6069 Form 6069, Return of Excise Tax on Excess Contributions to Black Lung.......	Form and Instruction
6069 Return of Excise Tax on on Excess Contributuins to Black Form 6069.pdf	Form and Instruction
6069 brdn_busi.PDF Form 6069 Burden Computation	IC Document

IC Title:

Form 6069, Return of Excise Tax on Excess Contributions to Black Lung.......

Agency IC Tracking Number:

jg-0049-019

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	6069	Return of Excise Tax on on Excess Contributuins to Black Lung Benefit Trust	Form 6069.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

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	1	1
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form 6069 Burden Computation	6069 brdn_busi.PDF	05/19/2008

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