Information Collection

Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)

IC 39687 under ICR 201904-1545-016 · OMB 1545-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0193 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FORM 4972 Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)	Form and Instruction
FORM 4972 Tax on Lump-Sum Distributions f4972--2018-00-00.pdf www.irs.gov/pub/irs-pdf/f4972.pdf	Form and Instruction
2019-4972-Burden-2019-03-28 13-53-20.pdf 2019 Burden	IC Document

IC Title:

Tax on Lump-Sum Distributions (From Qualified Retirement Plans of Plan Participants Born Before 1936)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 11.402(e)(4)(A) 26 CFR 11.402(e)(4)(B) 26 CFR 1.402(e)-2, 3, 14

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	FORM 4972	Tax on Lump-Sum Distributions	f4972--2018-00-00.pdf	https://www.irs.gov/pub/irs-pdf/f4972.pdf	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS 24.030--Customer Account Data Engine Individual Master File

FR Citation: 83 FR 42980

Number of Respondents: 17,720

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 16 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	17,720	17,720
Annual IC Time Burden (Hours)	77,968	77,968
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2019 Burden	2019-4972-Burden-2019-03-28 13-53-20.pdf	04/26/2019

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