Authorization to Furnish Financial Information and Certificate of Compliance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form TTB F 5030.6 Authorization to Furnish Financial Information and Certificate of Compliance	Form and Instruction	Modified	Available
1513-0004 Supporting Statement (2015-12-17).docx	Supporting Statement A	Uploaded 2015-12-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43832	Authorization to Furnish Financial Information and Certificate of Compliance	Form and Instruction	Modified

ICR Details

OMB Control No: 1513-0004	ICR Reference No: 201512-1513-001
Status: Historical Active	Previous ICR Reference No: 201210-1513-001
Agency/Subagency: TREAS/TTB	Agency Tracking No: IC 55 2/3
Title: Authorization to Furnish Financial Information and Certificate of Compliance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/11/2016
	Date Received in OIRA: 12/31/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	03/31/2016
Responses	240	0	2,000
Time Burden (Hours)	60	0	500
Cost Burden (Dollars)	0	0	0

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Abstract: The TTB regulations require applicants for alcohol and tobacco permits to provide certain information regarding the money used to finance the business. The Right to Financial Privacy Act of 1978 (the Act; 12 U.S.C. 3401 et seq.) limits government access to records held by financial institutions, provides for certain procedures to gain access to such information, and requires that government agencies certify to a financial institution that the agency has complied with all provisions of the Act. To comply with the requirements of the Act, TTB F 5030.6 acts as both a customer authorization to their financial institution providing TTB with the authority to receive the customer’s financial information and as the required certification by TTB to the financial institution that it has complied with the Act’s provisions.

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Authorizing Statute(s): US Code: 12 USC 3401-3422 Name of Law: Right to Financial Privacy Act of 1978
   US Code: 26 USC 5171 and 5271 Name of Law: Internal Revenue Code
   US Code: 26 USC 5712-5713 Name of Law: Internal Revenue Code
   US Code: 27 USC 203-204 Name of Law: Federal Alcohol Administration Act
  

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:
	80 FR 52093	08/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 81882	12/31/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Authorization to Furnish Financial Information and Certificate of Compliance	TTB F 5030.6	Authorization to Furnish Financial Information and Certificate of Compliance

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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	240	2,000	0	0	-1,760	0
Annual Time Burden (Hours)	60	500	0	0	-440	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: As an adjustment, we are revising the burden estimate to reflect a decrease in the number of respondents who complete TTB F 5030.6 and the resulting burden hours due to a decrease in the number of permit application investigations conducted by TTB that require access to records concerning applicants held by financial institutions.

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Annual Cost to Federal Government: $950

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]? No

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: 12/31/2015

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