Life Insurance Statement

ICR 201508-1545-016

OMB: 1545-0022

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2015-08-20
IC Document Collections
IC ID
Document
Title
Status
16757 Modified
ICR Details
1545-0022 201508-1545-016
Historical Active 201207-1545-037
TREAS/IRS
Life Insurance Statement
Extension without change of a currently approved collection   No
Regular
Approved without change 12/16/2015
Retrieve Notice of Action (NOA) 10/30/2015
  Inventory as of this Action Requested Previously Approved
12/31/2018 36 Months From Approved 12/31/2015
60,000 0 60,000
1,120,200 0 1,120,200
0 0 0

Form 712 is used to establish the value of life insurance policies for estate and gift tax purposes. The tax is based on the value of these policies. The form is completed by life insurance companies.

US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
  
None

Not associated with rulemaking

  80 FR 34961 06/18/2015
80 FR 66972 10/30/2015
No

1
IC Title Form No. Form Name
Life Insurance Statement 712 Life Insurance Statement

  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 60,000 60,000 0 0 0 0
Annual Time Burden (Hours) 1,120,200 1,120,200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$700
No
No
No
No
No
Uncollected
Esther Woodworth 202 622-3090

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/30/2015


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