Tax Exempt Hospitals Compliance Check Questionnaire

Forms and Documents

Document Name	Status
Compliance Check Questionaire-Hospital 2 Project(4-05-06).doc Supplementary Document	2006-10-10
SUPPORTING STATEMENT--hospital questionnaire.doc Supporting Statement A	2006-10-10

IC Document Collections

IC ID	Document Title	Status
19770	Tax Exempt Hospitals Compliance Check Questionnaire	Modified

ICR Details

OMB Control No: 1545-2015	ICR Reference No: 200610-1545-015
Status: Historical Inactive	Previous ICR Reference No: 200604-1545-032
Agency/Subagency: TREAS/IRS	Agency Tracking No: ah-2015-015
Title: Tax Exempt Hospitals Compliance Check Questionnaire
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 01/11/2007
	Date Received in OIRA: 10/17/2006
Terms of Clearance: The request is withdrawn because the hospital survey has already been sent and responses have been received.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	01/31/2007
Responses	0	0	545
Time Burden (Hours)	0	0	6,540
Cost Burden (Dollars)	0	0	0

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Abstract: A form to solicit information pertaining to the operations of tax exempt hospitals. Respondents will include hospitals claiming exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code.

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Authorizing Statute(s): US Code: 26 USC 501(c)(3) Name of Law: null
  

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:
	71 FR 44774	08/07/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 61140	10/17/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Tax Exempt Hospitals Compliance Check Questionnaire

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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: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 10/17/2006

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