Failure of Employer to Make Comparable Health Savings Account Contributions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8928 Return of Certain Excise Taxes Under chapter 43 of the IRC	Form	Modified	Repair queued
Form 8928 Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Form	Modified	Repair queued
Supporting Statement_1545-2146_Clean.docx	Supporting Statement A	Uploaded 2025-04-09	Repair queued
Supporting Statement_1545-2146_Clean.docx	Supporting Statement A	Uploaded 2025-04-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188460	Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Instruction	Modified
188460	Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Form	Modified	Return of Certain Excise Taxes Under chapter 43 of the IRC
188460	Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Form	Modified

ICR Details

OMB Control No: 1545-2146	ICR Reference No: 202412-1545-007
Status: Active	Previous ICR Reference No: 202201-1545-020
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Failure of Employer to Make Comparable Health Savings Account Contributions
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/11/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2025
Terms of Clearance: direct deposit option added to form during OMB review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2028	36 Months From Approved	09/30/2025
Responses	68	0	68
Time Burden (Hours)	1,597	0	1,597
Cost Burden (Dollars)	0	0	0

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Abstract: Form 8928 is used by employers, group health plans, HMOs, and third-party administrators to report and pay excise taxes due for failures under sections 4980B, 4980D, 4980E, and 4980G.

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Authorizing Statute(s): US Code: 26 USC 4980E Name of Law: Failure of employer to make comparable Archer MSA contributions.
   US Code: 26 USC 4980D Name of Law: Failure to meet certain group health plan requirements.
   US Code: 26 USC 4980B Name of Law: Failure to satisfy continuation coverage requirements of group health plans.
   US Code: 26 USC 4980G Name of Law: Failure of employer to make comparable health savings account contributions.
  

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:
	89 FR 82302	10/10/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 17507	04/25/2025
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
Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	8928	Return of Certain Excise Taxes Under chapter 43 of the IRC

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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	68	68	0	0	0	0
Annual Time Burden (Hours)	1,597	1,597	0	0	0	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:

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Annual Cost to Federal Government: $24,106

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.     Yes

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)? Yes

Is this ICR related to the Pandemic Response? No

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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: 04/30/2025

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