Form 4972---Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)

Forms and Documents

Document Name	Status
Form 4972 Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936) Form	Modified
Supporting_Statement-REV.doc Supporting Statement A	2012-10-25

IC Document Collections

IC ID	Document Title	Status
39687	Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936) Form	Modified

ICR Details

OMB Control No: 1545-0193	ICR Reference No: 201210-1545-002
Status: Historical Active	Previous ICR Reference No: 200909-1545-034
Agency/Subagency: TREAS/IRS	Agency Tracking No: EC-1545-0193-002
Title: Form 4972---Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)
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: 03/05/2013
	Date Received in OIRA: 10/25/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	03/31/2013
Responses	13,922	0	21,709
Time Burden (Hours)	61,257	0	95,520
Cost Burden (Dollars)	0	0	0

---

Abstract: IRC Section 402(e) allows taxpayers to compute a separate tax on a lump sum distribution from a qualified retirement plan. Form 4972 is used to correctly figure that tax. The data is used to verify the correctness of the separate tax. Form 4972 is also used to make the special 20% capital gain election attributable to pre-1974 participation from the lump-sum distribution.

---

Authorizing Statute(s): US Code: 26 USC 402 Name of Law: Taxability of beneficiary of employees' trust
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 25783	05/01/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 65052	10/24/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)	4972	Tax on Lump-Sum Distributions

---

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	13,922	21,709	0	0	-7,787	0
Annual Time Burden (Hours)	61,257	95,520	0	0	-34,263	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: The decrease in paperwork burden previously approved by OMB is due to adjustment to agency estimated number of responses/filers. The previous 2 renewals were based on the number of responses/filers who filed forms 4972 in 2003. The current estimate is based on the average number of responses/filers who filed form 4972 over the past 7 years.

---

Annual Cost to Federal Government: $70,717

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

---

Common Form ICR:  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:

(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: 10/25/2012

---