Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Department of the Treasury

The Department of the  Treasury has submitted the following public information collection requirement(s) to OMB for review and clearance under the Paperwork Reduction Act of 1995, Public Law 104-13. Copies of the submission(s) may be obtained by calling the Treasury Bureau Clearance Officer listed. Comments regarding this information collection should be addressed to the OMB reviewer listed and to the Treasury Department Clearance Officer, Department of the Treasury, Room 11000, 1750 Pennsylvania Avenue, NW., Washington, DC 20220. 

*Dates:*                     Written comments should be received on or before January 5, 2005 to be assured of consideration.                 

## Internal Revenue Service (IRS) 

*OMB Number:*                     1545-1753.                 

*Form Number:*                     IRS Form 10574.                 

*Type of Review:*                     Revision.                 

*Title:*                     Community Based Outlet Program.                 

*Description:*                     Form 10574 will be used by companies, businesses and government agencies to indicate their interest in participating in the IRS Community Based Outlet Program. This form will be returned to the CBOP analyst by fax or mail for appropriate action.                 

*Respondents:*                     Business or other for-profit, State, Local or Tribal Government.                 

*Estimated Number of Respondents:*                     25.                 

*Estimated Burden Hours Respondent:*                     5 Minutes.                 

*Frequency of response:*                     On occasion.                 

*Estimated Total Reporting Burden:*                     2 hours.                 

*Clearance Officer:*                     R. Joseph Durbala, (202) 622-3634, Internal Revenue Service, Room 6516, 1111 Constitution Avenue, NW., Washington, DC 20224.                 

*OMB Reviewer:*                     Joseph F. Lackey, Jr., (202) 395-7316, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503.                 

Christopher Davis,

Treasury PRA Assistant. 

[FR Doc. 04-26722 Filed 12-3-04; 8:45 am] 

BILLING CODE 4830-01-P