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###### Department of the Treasury

###### Internal Revenue Service

# AGENCY:

Internal Revenue Service (IRS), Treasury.

# ACTION:

Notice and request for comments.

# SUMMARY:

The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)).

# DATES:

Written comments should be received on or before April 13, 2015 to be assured of consideration.

# ADDRESSES:

Direct all written comments to Christie A. Preston, Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224.

Please send separate comments for each specific information collection listed below. You must reference the information collection's title, form number, reporting or record-keeping requirement number, and OMB number (if any) in your comment.

# FOR FURTHER INFORMATION CONTACT:

                        To obtain additional information, or copies of the information collection and instructions, or copies of any comments received, contact Elaine Christophe, at Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224, or through the internet, at                         *Elaine.H.Christophe@irs.gov.*

# SUPPLEMENTARY INFORMATION:

## Request for Comments

                    The Department of the Treasury and the Internal Revenue Service, as part of their continuing effort to reduce paperwork and respondent burden, invite the general public and other Federal agencies to take this opportunity to comment on the proposed or continuing information collections listed below in this notice, as required by the Paperwork Reduction Act of 1995, (44 U.S.C. 3501*et seq.*).                

*Request for Comments:*                     Comments submitted in response to this notice will be summarized and/or included in our request for Office of Management and Budget (OMB) approval of the relevant information collection. All comments will become a matter of public record. Please do not include any confidential or inappropriate material in your comments.                

*We invite comments on:*                     (a) Whether the collection of information is necessary for the proper performance of the agency's functions, including whether the information has practical utility; (b) the accuracy of the agency's estimate of the burden of the collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; (d) ways to minimize the burden of the collection of information on respondents, including the use of automated collection techniques or other forms of information technology; and (e) estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide the requested information.                

Currently, the IRS is seeking comments concerning the following forms, and reporting and record-keeping requirements:

*Title:*                     Distributions From an HSA, Archer MSA or Medical Advantage MSA.                

*OMB Number:*                     1545-1517.                

*Form Number:*                     1099-SA.                

*Abstract:*                     This form is used to report distributions from a medical savings account as required by Internal Revenue Code section 220(h).                

*Current Actions:*                     There are no changes being made to the form at this time.                

*Type of Review:*                     Extension of a currently approved collection.                

*Affected Public:*                     Business or other for-profit organizations.                

*Estimated Number of Responses:*                     25,839.                

*Estimated Time per Response:*                     8 min.                

*Estimated Total Annual Burden Hours:*                     3,618.                

*Title:*                     Payment of Gift/GST Tax and/or Application for Extension to File Form 709.                

*OMB Number:*                     1545-1913.                

*Form Number:*                     Form 8892                

*Abstract:*                     Form 8892 was created to serve a dual purpose. First, the form enables the taxpayers to request an extension of time to file Form 709 when they are not filing an individual income tax extension. Second, it serves as a payment voucher for taxpayers who are filing an individual income tax extension (by Form 4868) and will have a gift tax balance due on Form 709.                

*Current Actions:*                     There are no changes being made to the form at this time.                

*Type of Review:*                     Extension of a currently approved collection.                

*Affected Public:*                     Individuals or households.                

*Estimated Number of Respondents:*                     10,000.                

*Estimated Time per Respondent:*                     43 mins.                

*Estimated Total Annual Burden Hours:*                     7,200.                

The following paragraph applies to all of the collections of information covered by this notice:

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103.

Approved: February 3, 2015.

Christie A. Preston,

IRS Reports Clearance Officer.

[FR Doc. 2015-02639 Filed 2-9-15; 8:45 am]

BILLING CODE 4830-01-P