The agency is
not required to display the expiration date.
Inventory as of this Action
Requested
Previously Approved
10/31/2004
10/31/2004
10/31/2001
1,035,000
0
1,035,000
937,000
0
936,950
0
0
0
This form is used to compute and
collect taxes related to early distributions from individuals
retirement arrangements (IRAs) and other qualified retirement
plans; distributions from education (ED) IRAs not used for
educational expenses; excess contributions to traditional IRAs, ED
IRAs and medical savings accounts (MSAs); and excess accumulations
in qualified retire- ment plans.
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.