OMB # 1545-1920
CIRCUMSTANCES NECESSITATING COLLECTION OF INFORMATION
This form requests applicants to certify if they ever worked for the Federal Government and if they received a Buyout within the last 5 years. This is to ensure that applicants who meet the criteria are counseled that they are required to pay back the entire Buyout prior to entering on duty with the IRS.
Public Law (PL) 103-226 and PL 104-208; 5 CFR 550.710 and 550.771
USE OF DATA
Information on this form will be used to determine if an applicant was previously employed by the Federal Government, and if they received a Buyout within the last 5 years so they can be counseled by Personnel.
USE OF IMPROVED INFORMATION TECHNOLOGY TO REDUCE BURDEN
We have no plans at this time to offer electronic filing because of low volume compared to the cost of electronic enabling.
EFFORTS TO IDENTIFY DUPLICATION
We have attempted to eliminate duplication within the agency wherever possible.
METHODS TO MINIMIZE BURDEN ON SMALL BUSINESS OR OTHER SMALL ENTITIES
Not applicable
CONSEQUENCES OF LESS FREQUENT COLLECTION ON FEDERAL PROGRAMS OR POLICY ACTIVITIES
Not applicable
SPECIAL CIRCUMSTANCES REQUIRING DATA COLLECTION TO BE INCONSISTENT WITH GUIDELINES IN 5 CFR 1320.5(D) (2)
Not applicable
CONSULTATION WITH INDIVIDUALS OUTSIDE OF THE AGENCY ON AVAILABILITY OF DATA, FREQUENCY OF COLLECTION, CLARITY OF INSTRUCTIONS AND FORMS AND DATA ELEMENTS
Periodic meetings are held between IRS personnel and representatives of the American Bar Association, the National Society of Public Accountants, the American Institute of Certified Public Accountants, and other professional groups to discuss tax law and tax forms. During these meetings, there is an opportunity for those attending to make comments regarding Form 12311.
In response to the Federal Register notice dated July 8, 2014, (79 FR 38672), we received no comments during the comment period regarding Form 12311.
EXPLANATION OF DECISION TO PROVIDE ANY PAYMENT OR GIFT TO RESPONDENTS
Not applicable.
ASSURANCE OF CONFIDENTIALITY OF RESPONSES
Information submitted by applicants is confidential as required by 5 USC 552a
JUSTIFICATION OF SENSITIVE QUESTIONS
Title 26 USC 6109 requires inclusion of identifying numbers in returns, statements, or other documents for securing proper identification of persons required to make such returns, statements, or documents, and is the authority for social security numbers (SSNs) in IRS systems.
A privacy impact assessment (PIA) has been conducted for information collected under this request as part of the “Entry on Duty System (EODS)” and a Privacy Act System of Records notice (SORN) has been issued for this system under “Treasury .001--Treasury Payroll and Personnel System--Unique System Identifier: 015-00-01-13-01-1261-24.”
http://www.treasury.gov/SitePolicies/Pages/pia.aspx
ESTIMATED BURDEN OF INFORMATION COLLECTION
Number of Time per Total
Responses Response Hours
Form 12311 6,624 5 minutes 530
Estimates of the annualized cost to respondents for the hour burdens shown are not available at this time.
ESTIMATED TOTAL ANNUAL COST BURDEN TO RESPONDENTS
As suggested by OMB, our Federal Register notice dated July 8, 2014, (79 FR 38672), requested public comments on estimates of cost burden that are not captured in the estimates of burden hours, i.e., estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information. However, we did not receive any response from taxpayers on this subject. As a result, estimates of the cost burdens are not available at this time.
ESTIMATED ANNUALIZED COST TO THE FEDERAL GOVERNMENT
The primary cost to the government consists of the cost of printing. Printing of Form 12854 is done as part of an application booklet at a cost of $2,950.00 per 1,000.
REASONS FOR CHANGE IN BURDEN
The paperwork burden previously approved by OMB decreased by 32,555.
This form is also being submitted for renewal purposes.
PLANS FOR TABULATION, STATISTICAL ANALYSIS AND PUBLICATION
Not applicable.
REASONS WHY DISPLAYING THE OMB EXPIRATION DATE IS INAPPROPRIATE
We believe that displaying the OMB expiration date is inappropriate because it could cause confusion by leading taxpayers to believe that the information collection will sunset as of the expiration date. Taxpayers are not likely to be aware that the Service intends to request renewal of the OMB approval and obtain a new expiration date before the old OMB approval expires.
EXCEPTIONS TO THE CERTIFICATION STATEMENT ON OMB FORM 83I
Not applicable.
Note: The following paragraph applies to all of the collections of information in this submission.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential as required by 26 U.S.C. 6103.
| File Type | application/msword |
| File Title | Supporting Statement – Form 12885; Supplement to OF-612, Optional Application for Federal Employment |
| Author | ljmccar6 |
| Last Modified By | Department of Treasury |
| File Modified | 2014-12-04 |
| File Created | 2004-12-21 |