Form 5074 is used by U.S. citizens or
residents as an attachment to Form 1040 when they have $50,000 or
more in adjusted gross income from U.S. sources and $5,000 or more
in gross income from Guam or the Commonwealth of the Northern
Mariana Islands (CNMI). The data is used by IRS to allocate income
tax due to Guam or CNMI as required by 26 U.S.C. 7654.
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.