Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code

Form 8928- Return of Certain Excise Taxes Under Chapter 43 & TD 9457-Employer Comparable Contributions to HSAs and Requirement for filing excise taxes under sections 4980B, 4980D, 4980E and 4980G.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2146 can be found here:

Documents and Forms

Document Name Document Type
Form 8928 Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code Form
Form 8928 Instructions(Year 2013).pdf Instruction
8928 Return of Certain Excise Taxes Under chapter 43 of the I Form 8928 (Year 2013).pdf Form
Burden (2013).pdf Burden Computation Worksheet IC Document

Information Collection (IC) Details

IC Title:	Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Agency IC Tracking Number:	ARRA Act

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.6011-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8928	Return of Certain Excise Taxes Under chapter 43 of the IRC	Form 8928 (Year 2013).pdf		Yes	No	Fillable Printable
Instruction			Form 8928 Instructions(Year 2013).pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	100	-4,900	5,000
Annual IC Time Burden (Hours)	2,348	-152	2,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Computation Worksheet	Burden (2013).pdf	08/31/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.