Form 14417 - Reimbursable Agreement-Non-Federal Entities; Form 14417-A - Statistics of Income - User Fee

Forms and Documents

Document Name	Status
Form 14417-A Form 14417-A - Statistics of Income - User Fee Form	New
Form Form 14417 Form 14417--Reimbursable Agreement - Non-Federal Entities Form and Instruction	Modified
Supporting Statement.doc Supporting Statement A	2013-03-25

IC Document Collections

IC ID	Document Title	Status
206240	Form 14417-A - Statistics of Income - User Fee Form	New
203932	Form 14417--Reimbursable Agreement - Non-Federal Entities Form and Instruction	Modified

ICR Details

OMB Control No: 1545-2235	ICR Reference No: 201303-1545-026
Status: Historical Active	Previous ICR Reference No: 201209-1545-002
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 14417 - Reimbursable Agreement-Non-Federal Entities; Form 14417-A - Statistics of Income - User Fee
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: 07/18/2013
	Date Received in OIRA: 03/28/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	36 Months From Approved	07/31/2013
Responses	310	0	300
Time Burden (Hours)	160	0	150
Cost Burden (Dollars)	0	0	0

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Abstract: Information collected with this form will be used by the IRS to enter into cost reimbursable agreements with state, local, foreign government, and commercial entities. The authority to perform services on a cost reimbursable basis is contained in Section 6103(p) of the Internal Revenue Code. Performance of services is authorized when consistent with the basic public obligations of the IRS.

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Authorizing Statute(s): US Code: 26 USC 6103(p) Name of Law: Procedure and recordkeeping
  

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:
	78 FR 3498	01/16/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 19071	03/28/2013
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
Form 14417-A - Statistics of Income - User Fee	14417-A	Statistics of Income - User Fee
Form 14417--Reimbursable Agreement - Non-Federal Entities	Form 14417	Reimbursable Agreement--Non-Federal Entities

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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	310	300	0	10	0	0
Annual Time Burden (Hours)	160	150	0	10	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The authority to perform services on a cost reimbursable basis is contained in sections 6103 (p) and 6108 (b) of the IRC. The IRS enters into cost reimbursable agreements to provide services to federal and non-federal entities. Form 14417-A, Statistics of Income - User Fee, was developed to be used after a customer contacts the Statistics of Income (SOI) Division requesting data not already available on our TaxStats IRS website. The addition of Form 14417-A will result in 10 additional estimated burden hours and responses per year.

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Annual Cost to Federal Government: $80,000

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: 03/28/2013

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