Federal Register / Vol. 80, No. 27 / Tuesday, February 10, 2015 / Notices 7529 

through 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 information. 

Dated: February 3, 2015. 

Jennifer Shasky Calvery, 

Director, Financial Crimes Enforcement 

Network. 

[FR Doc. 2015–02731 Filed 2–9–15; 8:45 am] 

BILLING CODE 4810–2P–P 

DEPARTMENT OF THE TREASURY 

Internal Revenue Service 

Proposed Information Collection; 

Comment Request 

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 forprofit 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 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0165] 

Proposed Information Collection 

(Financial Status Report) Activity: 

Comment Request 

AGENCY: Office of Management, 

Department of Veterans Affairs. 

ACTION: Notice. 

SUMMARY: The Office of Management 

(OM), Department of Veterans Affairs 

(VA), is announcing an opportunity for 

public comment on the proposed 

collection of certain information by the 

agency. Under the Paperwork Reduction 

Act (PRA) of 1995, Federal agencies are 

required to publish notice in the 

Federal Register concerning each 

proposed collection of information, 

including each proposed revision of a 

currently approved collection, and 

allow 60 days for public comment in 

response to the notice. This notice 

solicits comments on information 

needed to determine a claimant’s 

financial status. 


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