Information Collection

Life Insurance Statement

IC 16757 under ICR 202110-1545-006 · OMB 1545-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0022 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 712 Life Insurance Statement	Form and Instruction
712 Life Insurance Statement Form 712.pdf	Form and Instruction

IC Title:

Life Insurance Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 25.6001-1(b) 26 CFR 20.6018-4

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	712	Life Insurance Statement	Form 712.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: IRS 42.021-Compliance Programs and Project Files.

FR Citation: 80 FR 54064

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	1,120,200	1,120,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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