Information Collection

Life Insurance Statement

IC 16757 under ICR 201508-1545-016 · OMB 1545-0022.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0022 can be found here:

Documents and Forms

Document Name Document Type
Form 712 Life Insurance Statement Form and Instruction
712 Life Insurance Statement Form 712.pdf Form and Instruction
brdn_busi.pdf Burden IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Life Insurance Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 20.6018-4 26 CFR 25.6001-1(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	712	Life Insurance Statement	Form 712.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	60,000	60,000
Annual IC Time Burden (Hours)	1,120,200	1,120,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden	brdn_busi.pdf	08/20/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.