FORM IS USED TO DETERMINE THE AMOUNT
OF SPECIAL TAX LIABILITY OF CATERS WHO SELL AT A LOCATION OTHER
THAN THEIR PRINCIPAL PLACE OF BUSINESS ALCOHOLIC BEVERAGES BY THE
DRINK. DESCRIBES THE CATERER AND HIS PRINCIPAL BUSINESS OFFICE, AND
DETAILS OF PLACES WHERE THE CATERER SOLD ALCOHOLIC BEVERAGES BY THE
DRINK. FORM IS ATTACHED BY THE CARTERER WITH HIS PAYMENT AND IRS
FORM 11.
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:
(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;
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.