Long-Term Care and Accelerated Death Benefits.

Forms and Documents

Document Name	Status
Form 1099-LTC Long-Term Care and Accelerated Death Benefits. Form	Modified
Sup Stmnt Form 1099-LTC.doc Supporting Statement A	2011-12-08

IC Document Collections

IC ID	Document Title	Status
18587	Long-Term Care and Accelerated Death Benefits. Form	Modified

ICR Details

OMB Control No: 1545-1519	ICR Reference No: 201112-1545-013
Status: Historical Active	Previous ICR Reference No: 200810-1545-025
Agency/Subagency: TREAS/IRS	Agency Tracking No: jg-1519-013
Title: Long-Term Care and Accelerated Death Benefits.
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/28/2011
	Date Received in OIRA: 12/15/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved	12/31/2011
Responses	79,047	0	79,047
Time Burden (Hours)	18,181	0	18,181
Cost Burden (Dollars)	0	0	0

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Abstract: Under the terms of IRC sections 7702B and 101g, qualified long- term care and accelerated death benefits paid to chronically ill individuals are treated as amounts received for expenses incurred for medical care. Amounts received on a per diem basis in excess of $175 per day are taxable. Section 6050Q requires all such amounts to be reported.

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Authorizing Statute(s): US Code: 26 USC 6050 Name of Law: Information Concerning Transactions With Other Persons
   US Code: 26 USC 7702 Name of Law: Life insurance contract defined
   US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
   US Code: 26 USC 101 Name of Law: Certain death benefits
  

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 51128	08/17/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 78081	12/15/2011
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
Long-Term Care and Accelerated Death Benefits.	1099-LTC	Long-Term Care and Accelerated Death Benefits

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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	79,047	79,047	0	0	0	0
Annual Time Burden (Hours)	18,181	18,181	0	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:

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Annual Cost to Federal Government: $20,772

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)? 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: 12/15/2011

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