Form 3921 - Exercise of an Incentive Stock Option Under...; Form 3922 - Transfer of Stock Acquired Through an ...; TD 9470 - Information Reporting Requirements Under Code Sec. 6039

Forms and Documents

Document Name	Status
Form 3922 Form 3922 - Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under Section 423(c) Form	Modified
Form 3921 Form 3921 - Exercise of an Incentive Stock Option Under Section 422(b). Form	Modified
2018-02-06_SS_1545-2129rMB.docx Supporting Statement A	2018-02-06

IC Document Collections

IC ID	Document Title	Status
186592	TD 9470 - Information Reporting Requirements Under Internal Revenue Service Code Sec. 6039	Modified
186591	Form 3922 - Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under Section 423(c) Form	Modified
186590	Form 3921 - Exercise of an Incentive Stock Option Under Section 422(b). Form	Modified

ICR Details

OMB Control No: 1545-2129	ICR Reference No: 201712-1545-014
Status: Active	Previous ICR Reference No: 201409-1545-016
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 3921 - Exercise of an Incentive Stock Option Under...; Form 3922 - Transfer of Stock Acquired Through an ...; TD 9470 - Information Reporting Requirements Under Code Sec. 6039
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 without change	Conclusion Date: 04/26/2018
	Date Received in OIRA: 02/14/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved	04/30/2018
Responses	51,000	0	51,000
Time Burden (Hours)	25,205	0	25,205
Cost Burden (Dollars)	0	0	0

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Abstract: Form 3921 is a copy of the information return filed with the IRS which transferred shares of stock to a recipient through exercise of an incentive stock option under section 422(b). Form 3922 is used to record a transfer of the legal title of a share of stock acquired by the employee where the stock was acquired pursuant to the exercise of an option described in section 423(c). Previously approved REG-103146-08 reflects the changes to section 6039 of the Internal Revenue Code made by section 403 of the Tax Relief and Health Care Act of 2006.

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Authorizing Statute(s): US Code: 26 USC 6039 Name of Law: Information required in connection with certain options
   PL: Pub.L. 109 - 432 403 Name of Law: Tax Relief and Health Care Act of 2006
   US Code: 26 USC 7805 Name of Law: Rules and regulations
  

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:
	82 FR 55714	11/22/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 6732	02/14/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
TD 9470 - Information Reporting Requirements Under Internal Revenue Service Code Sec. 6039
Form 3921 - Exercise of an Incentive Stock Option Under Section 422(b).	3921	Excise of an Incentive Stock Option Under Section 422(b)
Form 3922 - Transfer of Stock Acquired Through an Employee Stock Purchase Plan Under Section 423(c)	3922	Transfer of Stock Acquired Through an Employee Stock Purchases Plan Under Section 423(c)

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ICR Summary 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	51,000	51,000	0	0	0	0
Annual Time Burden (Hours)	25,205	25,205	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: $6,500

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)? No

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: 02/14/2018

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