Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code

Failure of Employer to Make Comparable Health Savings Account Contributions

Documents and Forms

Document Name Document Type
Form 8928 Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code Form
8928 Return of Certain Excise Taxes Under chapter 43 of the IRC f8928--2016-05-00.pdf Form
i8928--2016-09-00.pdf Instruction
2024-8928-Burden-2024-10-07 11-09-13.pdf Burden Computation Worksheet IC Document

Information Collection (IC) Details

IC Title:	Form 8928 - Return of Certain Excise Taxes Under Chapter 43 of the Internal Revenue Code	Agency IC Tracking Number:	1545-2146

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.6011-2

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8928	Return of Certain Excise Taxes Under chapter 43 of the IRC	f8928--2016-05-00.pdf		Yes	No	Fillable Printable
Instruction			i8928--2016-09-00.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: IRS 24.046 BMF Business Master File	FR Citation: 80 FR 54063

Number of Respondents: 68	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	68	68
Annual IC Time Burden (Hours)	1,597	1,597
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Burden Computation Worksheet	2024-8928-Burden-2024-10-07 11-09-13.pdf	12/10/2024

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