View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1545-0949	ICR Reference No: 202107-1545-010
Status: Historical Active	Previous ICR Reference No: 201805-1545-015
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 2587 - Application for Special Enrollment Examination
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: 02/17/2022
	Date Received in OIRA: 12/31/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2025	36 Months From Approved	02/28/2022
Responses	15,643	0	11,000
Time Burden (Hours)	1,564	0	1,100
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	15,643	11,000	4,643
Annual Time Burden (Hours)	1,564	1,100	464
Annual Cost Burden (Dollars)	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: Changes in burden previously approved by OMB resulted from an adjustment to estimates made by the Department reflecting the increased number of responses based on its most recent data on Form 2587 filings, from 11,000, to 15,643. The total annual burden hours increased from 1,100 to 1,564.

Annual Cost to Federal Government: $5,000

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? No

Agency Contact: Stan Oshinsky 202 622-8216

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