Long-Term Care and Accelerated Death Benefits.

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1099 LTC Form 1099-LTC - Long-Term Care and Accelerated Death Benefits.	Form	Modified	Available
2019-06-19_SS_1545-1519rKD.docx	Supporting Statement A	Uploaded 2019-07-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
18587	Form 1099-LTC - Long-Term Care and Accelerated Death Benefits.	Form	Modified

ICR Details

OMB Control No: 1545-1519	ICR Reference No: 201809-1545-022
Status: Active	Previous ICR Reference No: 201305-1545-035
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Long-Term Care and Accelerated Death Benefits.
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: 07/18/2019
	Date Received in OIRA: 11/30/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	36 Months From Approved	07/31/2019
Responses	377,467	0	292,500
Time Burden (Hours)	86,818	0	67,275
Cost Burden (Dollars)	0	0	0

---

Abstract: Under the terms of IRC sections 7702B and 101g, qualified long- term care and accelerated death benefits paid to chronically ill individuals are treated as amounts received for expenses incurred for medical care. Amounts received on a per diem basis in excess of $175 per day are taxable. Section 6050Q requires all such amounts to be reported. Form 1099-LTC is used if any long-term care benefits, including accelerated death benefits are paid. Payers include insurance companies, governmental units, and viatical settlement providers.

---

Authorizing Statute(s): US Code: 26 USC 6103 Name of Law: Confidentiality and disclosure of returns and return information
   US Code: 26 USC 6050 Name of Law: Information Concerning Transactions With Other Persons
   US Code: 26 USC 101 Name of Law: Certain death benefits
   US Code: 26 USC 7702 Name of Law: Life insurance contract defined
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 38765	08/07/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 61722	11/30/2018
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Form 1099-LTC - Long-Term Care and Accelerated Death Benefits.	1099 LTC, 1099-LTC (draft)	Long-Term Care and Accelerated Death Benefits ,   Long-Term Care and Accelerated Death Benefits

---

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	377,467	292,500	0	0	84,967	0
Annual Time Burden (Hours)	86,818	67,275	0	0	19,543	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: The agency has updated its estimated number of responses based on its most recent filing data. There is an increase of 84,967 responses (292,500 to 377,467). This increase results in an annual time burden increase of 19,543 hours (67,275 + 19,543 = 86,818 hours).

---

Annual Cost to Federal Government: $73,586

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  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:

(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: 11/30/2018

---