Supplemental Income and Loss

Forms and Documents

Document Name	Status
Form 1040 Sch. E Supplemental Income and Loss Form	Modified
Expiration Explanation.rtf Supplementary Document	2009-09-16
SS.doc Supporting Statement A	2012-11-27

IC Document Collections

IC ID	Document Title	Status
43898	Supplemental Income and Loss Form	Modified

ICR Details

OMB Control No: 1545-1972	ICR Reference No: 201211-1545-041
Status: Historical Active	Previous ICR Reference No: 200909-1545-025
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-1972-025
Title: Supplemental Income and Loss
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/25/2013
	Date Received in OIRA: 11/29/2012
Terms of Clearance: Burden change reclassified as change due to agency estimate.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved	03/31/2013
Responses	45,463	0	45,463
Time Burden (Hours)	284,144	0	284,599
Cost Burden (Dollars)	0	0	0

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Abstract: Schedule E (Form 1040) is used by individuals to report their supplemental income. The data is used to verify that the items reported on the form is correct and also for general statistical use.

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Authorizing Statute(s): US Code: 26 USC 6012 Name of Law: Persons required to make returns of income.
   US Code: 26 USC 6011 Name of Law: General requirements of return, statement, or list.
  

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 37100	06/20/2012
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: 1

IC Title	Form No.	Form Name
Supplemental Income and Loss	1040 Sch. E	Supplemental Income and Loss

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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	45,463	45,463	0	0	0	0
Annual Time Burden (Hours)	284,144	284,599	0	0	-455	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: The Arthur D. Little burden calculation method variables in this form were recounted and a new baseline was established. This resulted in a net decrease of 455 burden hours from 2009.

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Annual Cost to Federal Government: $15,000,000

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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