Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons and Form 6069, Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Under Sectio

Forms and Documents

Document Name	Status
Form 6069 Form 6069--Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Form and Instruction	Modified
Form 990-BL Form 990-BL-- Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons Form	Modified
2018-09-10_SS_1545-0049rSC.docx Supporting Statement A	2018-09-06

IC Document Collections

IC ID	Document Title	Status
184974	Form 6069--Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Form and Instruction	Modified
16806	Form 990-BL-- Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons Form	Modified

ICR Details

OMB Control No: 1545-0049	ICR Reference No: 201805-1545-013
Status: Active	Previous ICR Reference No: 201411-1545-003
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons and Form 6069, Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Under Sectio
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: 12/06/2018
	Date Received in OIRA: 10/29/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2021	36 Months From Approved	12/31/2018
Responses	23	0	23
Time Burden (Hours)	764	0	764
Cost Burden (Dollars)	0	0	0

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Abstract: IRS uses Form 990-BL to monitor activities of black lung benefit trusts, and to collect excise taxes on these trusts and certain related persons if they engage in proscribed activities. The tax is figured on Schedule A of Form 990-BL. Form 6069 is used by coal mine operators to figure the maximum deduction to a black lung benefit trust. If excess contributions are made, IRS uses the form to figure and collect the tax on excess contributions.

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Authorizing Statute(s): US Code: 26 USC 501(c)(21) Name of Law: A trust or trusts established in writing, created or organized in the United States, and contributed
   US Code: 26 USC 6033 Name of Law: Returns by exempt organizations
   US Code: 26 USC 4951 Name of Law: Taxes on self-dealing
  

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:
	83 FR 13347	03/28/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 54415	10/29/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Form 6069--Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust	6069	Return of Excise Tax on Excess Contributions to Black Lung Benefit Trust Under Section 4953 and Computation of Section 192 Deduction
Form 990-BL-- Information and Initial Excise Tax Return for Black Lung Benefit Trusts and Certain Related Persons	990-BL	Information and Initial Excise Tax Return forBlack Lung Benefit Trusts and Certain Related Persons

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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	23	23	0	0	0	0
Annual Time Burden (Hours)	764	764	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: $19,762

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: 10/29/2018

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