Form 1040-SS - U.S. Self-Employment Tax Return; Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Sch. H. (Form 1040 Contribuciones sobre el Empleo de Empleados Domésticos	Form	Modified	Available
Form 1040-PR Planilla para la Declaracion de la Contribucion Federal sobre el Trabajo por Cuento Propia (Incluyendo el Credito Tributario Adicional por Hijos para Residentes Bona Fide de Puerto Rico)	Form	Modified	Available
Form 1040-SS U.S. Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)	Form	Modified	Available
1545-0090_Supporting_Statement_03DEC14.doc	Supporting Statement A	Uploaded 2014-12-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
185781	Anejo H-PR - (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos	Form	Modified	Contribuciones sobre el Empleo de Empleados Domésticos
185781	Anejo H-PR - (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos	Other-2014 DRAFT SCH H (Form 1040-PR)	Modified
185776	Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico	Form	Modified	Planilla para la Declaracion de la Contribucion Federal sobre el Trabajo por Cuento Propia (Incluyendo el Credito Tributario Adicional por Hijos para Residentes Bona Fide de Puerto Rico)
185776	Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico	Other-2014 DRAFT Form 1040-PR	Modified
16891	Form 1040-SS, U.S. Self-Employment Tax Return	Form	Modified	U.S. Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)
16891	Form 1040-SS, U.S. Self-Employment Tax Return	Other-2014 DRAFT Form 1040-SS	Modified

ICR Details

OMB Control No: 1545-0090	ICR Reference No: 201409-1545-002
Status: Historical Active	Previous ICR Reference No: 201108-1545-024
Agency/Subagency: TREAS/IRS	Agency Tracking No: GJS - Ready
Title: Form 1040-SS - U.S. Self-Employment Tax Return; Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico; and Anejo H-PR,
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: 03/25/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/29/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved	03/31/2015
Responses	246,860	0	246,860
Time Burden (Hours)	2,847,448	0	2,801,605
Cost Burden (Dollars)	0	0	0

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Abstract: Form 1040-SS (Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands) and 1040-PR (Puerto Rico) are used by self-employed individuals to figure and report self-employment tax under IRC chapter 2 of Subtitle A, and provide credit to the taxpayer's social security account. Anejo H-PR is used to compute household employment taxes. Form 1040-SS and Form 1040-PR are also used by bona-fide residents of Puerto Rico to claim the additional child tax credit.

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Authorizing Statute(s): US Code: 26 USC 7651 Name of Law: Administration and collection of taxes and possessions.
   US Code: 26 USC 1401 Name of Law: Rate of tax.
   US Code: 26 USC 1402 Name of Law: Definitions
   US Code: 26 USC 6017 Name of Law: Self-employment tax returns.
  

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:
	79 FR 37394	07/01/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 77084	12/23/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Anejo H-PR - (1040 (Sch H) PR); Contribuciones sobre el Empleo de Empleados Domesticos	Sch. H. (Form 1040-PR)	Contribuciones sobre el Empleo de Empleados Domésticos
Form 1040-PR - Planilla Para La Declaracion De La Contribucion Federal Sobre El Trabajo Por Cuenta Propia-Puerto Rico	1040-PR	Planilla para la Declaracion de la Contribucion Federal sobre el Trabajo por Cuento Propia (Incluyendo el Credito Tributario Adicional por Hijos para Residentes Bona Fide de Puerto Rico)
Form 1040-SS, U.S. Self-Employment Tax Return	1040-SS	U.S. Self-Employment Tax Return (Including the Additional Child Tax Credit for Bona Fide Residents of Puerto Rico)

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ICR Summary of Burden

table that charts list 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	246,860	246,860	0	0	0	0
Annual Time Burden (Hours)	2,847,448	2,801,605	0	45,843	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: An additional line was added to reflect the Additional Medicare Tax from Form 8959 [P.L.111-148, Act Sec. 9015 (IRC section 1401(b)(2))]. This change will increase the total burden to 2,847,448 hours, which will result in a program change increase of 45,843 hours.

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Annual Cost to Federal Government: $261,673

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]? Yes

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: 12/29/2014

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