Form 8935 - Airplane Payments Report

Forms and Documents

Document Name	Status
Form 8935-T 8935-T, Transmittal of Airline Payments Reports Form and Instruction	Modified
Form 8935 Form 8935 - Airplane Payments Report Form	Modified
PL 110-458.pdf Supplementary Document	2009-02-23
Supporting Statement.pdf Supporting Statement A	2012-11-14

IC Document Collections

IC ID	Document Title	Status
189012	8935-T, Transmittal of Airline Payments Reports Form and Instruction	Modified
188134	Form 8935 - Airplane Payments Report Form	Modified

ICR Details

OMB Control No: 1545-2140	ICR Reference No: 201211-1545-013
Status: Historical Active	Previous ICR Reference No: 200909-1545-010
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-2140-013
Title: Form 8935 - Airplane Payments Report
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: 12/30/2012
	Date Received in OIRA: 11/29/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved	12/31/2012
Responses	40	0	40
Time Burden (Hours)	44	0	44
Cost Burden (Dollars)	0	0	0

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Abstract: Form 8935 will provide to the employee, current or former, the amount of the payment that was received from the airline that is eligible for rollover treatment into a Roth IRA. Form 8935-T is a transmittal form developed for filing information reporting Forms 8935, Airline Payments Reports, with the Service via paper filing.

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Authorizing Statute(s): PL: Pub.L. 110 - 458 125 Name of Law: WORKER, RETIREE, AND EMPLOYER RECOVERY ACT OF 2008
  

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:
	77 FR 57191	09/17/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 71208	11/29/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
8935-T, Transmittal of Airline Payments Reports	8935-T	Transmittal of Airline Payments Reports
Form 8935 - Airplane Payments Report	8935	Airplane Payments Report

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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	40	40	0	0	0	0
Annual Time Burden (Hours)	44	44	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: $5,000

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: 11/29/2012

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