Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

Forms and Documents

Document Name	Status
Form 990 Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form	Unchanged
Form Schedule R (F 990) Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form	Unchanged
Form Schedule N (Form 9 Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form	Unchanged
Form Schedule M (F 990) Schedule M - Non-Cash Contributions Form	Unchanged
Form Schedule L (Form 9 Schedule L - Transactions with Interested Persons Form	Unchanged
Form Schedule K (Form 9 Schedule K - Supplemental Information on Tax Exempt Bonds Form	Unchanged
Form Schedule J (F 990) Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form	Unchanged
Form Schedule I (Form 9 Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form	Unchanged
Form Schedule H (F 990) Schedule H - Hospitals Form	Unchanged
Form Schedule G (Form 9 Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form	Unchanged
Form Schedule F (Form 9 Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form	Unchanged
Form Schedule E (F 990) Schedule E - Schools Form	Unchanged
Form Schedule D (Form 9 Schedule D - Supplemental Financial Statements Form	Unchanged
Form 990 Sch. C Schedule C - Political Campaign and Lobbying Activities Form	Unchanged
Form Schedule B (Form 9 Schedule B - Schedule of Contributors Form and Instruction	Unchanged
Form Schedule A (Form 9 Schedule A - Public Charity Status and Public Support Form	Unchanged
RP 2015-21 Supporting Statement_Red Line 3-6-15.docx Supporting Statement A	2015-03-09
justification statement.docx Justification for No Material/Nonsubstantive Change	2015-02-26
Justification.docx Justification for No Material/Nonsubstantive Change	2014-12-30
Justification_Statement[1].docx Justification for No Material/Nonsubstantive Change	2014-12-23
Justification Statement.docx Justification for No Material/Nonsubstantive Change	2014-11-19

IC Document Collections

IC ID	Document Title	Status
39403	Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form	Unchanged
215357	RP 2015-12 - Guidance regarding correction and disclosure procedures for hospital organizations Other-Revenue Procedure	New
184772	Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form	Unchanged
184771	Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form	Unchanged
184770	Schedule M - Non-Cash Contributions Form	Unchanged
184769	Schedule L - Transactions with Interested Persons Form	Unchanged
184768	Schedule K - Supplemental Information on Tax Exempt Bonds Form	Unchanged
184767	Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form	Unchanged
184765	Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form	Unchanged
184764	Schedule H - Hospitals Form	Unchanged
184763	Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form	Unchanged
184762	Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form	Unchanged
184753	Schedule E - Schools Form	Unchanged
184752	Schedule D - Supplemental Financial Statements Form	Unchanged
184751	Schedule C - Political Campaign and Lobbying Activities Form	Unchanged
184750	Schedule B - Schedule of Contributors Form and Instruction	Unchanged
184749	Schedule A - Public Charity Status and Public Support Form	Unchanged

ICR Details

OMB Control No: 1545-0047	ICR Reference No: 201412-1545-007
Status: Historical Active	Previous ICR Reference No: 201411-1545-036
Agency/Subagency: TREAS/IRS	Agency Tracking No: not-ready
Title: Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/26/2015
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/09/2015
	Date Received in OIRA: 02/26/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	6 Months From Approved	04/30/2017
Responses	406,023	0	403,068
Time Burden (Hours)	24,951,529	0	24,945,619
Cost Burden (Dollars)	0	0	0

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Abstract: Form 990 is needed to determine that IRC section 501(a) tax-exempt organizations fulfill the operating conditions within the limitations of their tax exemption. Form 990 is used by tax-exempt organizations, nonexempt charitable trusts, and section 527 political organizations to provide the IRS with the information required by section 6033.

Emergency Justfication: The statutory requirements of § 501(r) (except for § 501(r)(3)) apply to taxable years beginning after March 23, 2010. Section 501(r)(3) applies to taxable years beginning after March 23, 2012. On December 29, 2014, the Department of the Treasury (“Treasury Department”) and the Internal Revenue Service (“IRS”) released final regulations (TD 9708) that contain guidance on the requirements of § 501(r)(3) through (r)(6) and the consequences for failing to meet any of the § 501(r) requirements. This revenue procedure provides guidance regarding correction and disclosure procedures for hospital organizations to follow so that certain failures to meet the requirements of § 501(r) of the Internal Revenue Code will be excused for purposes of § 501(r)(1) and 501(r)(2)(B). Failure to provide this guidance could prevent not-for-profit hospital organizations from maintaining or being treated as described in section 501(c)(3) of the tax Code.

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Authorizing Statute(s): US Code: 26 USC 4947 Name of Law: Application of taxes to certain nonexempt trusts
   US Code: 26 USC 501 Name of Law: Exemption from tax on corporations, certain trusts, etc.
   US Code: 26 USC 527 Name of Law: Political organizations
   US Code: 26 USC 6033 Name of Law: Returns by exempt organizations
  

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 59707	09/28/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 24804	04/26/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 17

IC Title	Form No.	Form Name
RP 2015-12 - Guidance regarding correction and disclosure procedures for hospital organizations
Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R	Schedule R-1 (F 990), Schedule R (F 990)	Related Organizations and Unrelated Partnerships ,   Continuation Sheet for Schedule R
Schedule K - Supplemental Information on Tax Exempt Bonds	Schedule K (Form 990)	Supplemental Information on Tax Exempt Bonds
Schedule L - Transactions with Interested Persons	Schedule L (Form 990 or 990-EZ)	Transactions with Interested Persons
Schedule M - Non-Cash Contributions	Schedule M (F 990)	Non-Cash Contribution
Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990	Schedule J (F 990), Schedule J-1 (F 990), Schedule J-2 (F 990)	Compensation Information ,   Continuation Sheet for Sch J ,   Continuation Sheet for Form 990
Schedule A - Public Charity Status and Public Support	Schedule A (Form 990 or 990EZ), Schedule A (Form 990 or 990EZ), Schedule A (Form 990 or 990EZ)	Public Charity Status and Public Support ,   Public Charity Status and Public Support ,   Public Charity Status and Public Support
Schedule B - Schedule of Contributors	Schedule B (Form 990)	Schedule of Contributors
Schedule E - Schools	Schedule E (F 990)	Schools
Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990	Schedule O, 990	Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ,   Supplemental Information to Form 990
Schedule C - Political Campaign and Lobbying Activities	990 Sch. C	Polical Campaign and Lobbying Activities
Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N	Schedule N-1, Schedule N (Form 990 or 990-EZ)	Liquidation, Termination, Dissolution or Significant Disposition of Assets ,   Continuation Sheet of Schedule N
Schedule H - Hospitals	Schedule H (Form 990), Schedule H (F 990), Schedule H (Form 990)	Hospitals ,   Hospitals ,   Hospitals
Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I	Schedule I-I (Form 990), Schedule I (Form 990)	Grants and Other Assistance to Organizations, Governments and Individuals in the U.S. ,   Continuation Sheet for Schedule I (Form 990)
Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F	Schedule F-1 (Form 990), Schedule F (Form 990)	Statement of Activities Outside the United States ,   Continuation Sheet for Schedule F
Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities	Schedule G (Form 990 or 990-EZ)	Supplemental Information Regarding Fundraising or Gaming Activities
Schedule D - Supplemental Financial Statements	Schedule D (Form 990)	Supplemental Financial Statements

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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	406,023	403,068	0	2,955	0	0
Annual Time Burden (Hours)	24,951,529	24,945,619	0	5,910	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: Changing Regulations

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

Burden Reduction Due to:

Short Statement: Section 9007 of the Patient Protection and Affordable Care Act, Public Law 111-148 (124 Stat. 119 (2010)), enacted § 501(r), imposes additional requirements on charitable hospital organizations. Section 501(r)(1) provides that a hospital organization described in § 501(r)(2) will not be treated as described in § 501(c)(3) unless the organization meets the requirements of § 501(r)(3) through (r)(6). Section 7.01, of Rev. Proc. 2015-21, describes the information that must be disclosed and requires all disclosure to be made on the Form 990. Section 7.02 applies only to hospital organizations that are not required to file Form 990 and permits such organizations to disclose the information described in section 7.01 on a Web site rather than on a Form 990. In response to the comments regarding Notice 2014-3 and to conform this revenue procedure (RP 2015-12) to the final regulations under § 501(r) (TD 9708), this revenue procedure includes changes to the revenue procedure proposed in Notice 2014-3. The collections of information in this revenue procedure are in sections 7.01 and 7.02. Section 7.01 describes the information that must be disclosed and requires all disclosure to be made on the Form 990. Section 7.02 applies only to hospital organizations that are not required to file Form 990. The Treasury Department and the IRS have reached the following reporting burden estimates for those organizations disclosing information pursuant to sections 7.01 and 7.02: Estimated number of recordkeepers: 2,955 Estimated average annual burden hours per recordkeeper: 2 Estimated total annual reporting burden: 5,910

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Annual Cost to Federal Government: $20,000

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]? 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: 02/26/2015

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