Form 5434-A - Application For Renewal Of Enrollment - Joint Board For The Enrollment Of Actuaries - 2012 Page 2
Download a blank fillable Form 5434-A - Application For Renewal Of Enrollment - Joint Board For The Enrollment Of Actuaries - 2012 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 5434-A - Application For Renewal Of Enrollment - Joint Board For The Enrollment Of Actuaries - 2012 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
24. If you are not reporting continuing education credit because you were initially enrolled between
January 1, 2010 and December 31, 2010, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. If you are not reporting continuing education credit because you have received a waiver of that requirement,
attach a copy of the waiver and check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Declaration and Signature
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is
true, correct, and complete.
6a. Signature
6b. Date Signed
Privacy Act and Paperwork Reduction Act Notice
Section 1242, United States Code, authorizes the Joint Board for the Enrollment of Actuaries (Joint Board) to collect this information.
The primary use of the information is to enforce and administer the regulations of the Joint Board governing the practice of an actuary
under the Employee Retirement Income Security Act of 1974 (ERISA). Information may be disclosed to: the Department of Justice
when seeking advice or for use in any proceeding; courts and other adjudicative bodies during a proceeding; public authorities for their
use in connection with employment, contracting, licensing, and other benefits; pubic authorities for their use in connection with their
regulatory, enforcement, investigative, or prosecutorial responsibilities; contractors as necessary for performance of the contract; third
parties as necessary during an investigation; the Department of Labor, the Department of the Treasury, and the Pension Benefit
Guaranty Corporation for administering and enforcing ERISA or in connection with maintaining standards of integrity, conduct, and
discipline on the part of individuals who practice before such agencies; the general public (including disclosures via web sites) for the
purpose of publicizing or verifying the enrollment status and location of individuals who are, or were, enrolled actuaries; professional
organizations or associations for their use in connection with maintaining standards of integrity, conduct, and discipline; appropriate
agencies, entities, and persons when the Joint Board suspects or confirms that the security or confidentiality of information in a system
of records has been compromised, as necessary to prevent, minimize, or remedy harm. Applying for renewal of enrollment is
voluntary; however, providing the information requested on this form is a requirement to obtain the benefit of renewal of enrollment.
Failure to provide the requested information could delay or prevent processing of your application. Providing false information could
subject you to penalties.
Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure
to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of
information displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to
average 30 minutes per response, including the time for reviewing the instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Joint Board for the
Enrollment of Actuaries c/o IRS/Office of Professional Responsibility; SE:OPR; 1111 Constitution Avenue, NW; Washington, DC 20224.
5434-A
Catalog Number 63767O
Department of the Treasury - Internal Revenue Service
Form
(Rev. 3-2012)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 5434-a - Application For Renewal Of Enrollment - Joint Board For The Enrollment Of Actuaries - 2017
Financial
Form Mv-141 - Application For The Replacement Of A Lost, Stolen Or Mutilated I. R. P. License Plate
Financial
Related Categories
Parent category: Financial