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⚠️ Notice: This information collection may be referencing outdated material.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
i8928--2016-09-00.pdf Instruction
8928 Return of Certain Excise Taxes Under chapter 43 of the I f8928--2016-05-00.pdf Form
2018-8928-Burden-2018-06-28 16-37-33.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	f8928--2016-05-00.pdf		Yes	No	Fillable Printable
Instruction			i8928--2016-09-00.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: IRS 24.046 BMF Business Master File	FR Citation: 80 FR 54064

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	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	2,348	2,348
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Computation Worksheet	2018-8928-Burden-2018-06-28 16-37-33.pdf	06/28/2018

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