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Use Form 4506-A, Request for Public Inspection or Copy of Exempt

Specific Instructions

or Political Organization IRS Form, to request a copy or to inspect an

exempt organization return through IRS. There is a fee for

photocopying, but not for inspection at an IRS office.

Identification Area

Through the organization — Annual return. An organization must,

Period Covered by the Return. Enter the calendar year or fiscal year

during the 3-year period beginning with the due date (including

that corresponds to the accounting period being reported.

extensions) of the Form 990-BL (or, if later, the date it is actually filed),

Name and Address. Enter the name and address of the trust.

make its return available for public inspection. It must also provide

copies of either all items that are available for public inspection or

If the return and a Schedule A (Form 990-BL) are filed by a trustee

specifically identified items, if so requested. All parts of the return and

or disqualified person liable for tax under section 4951 or 4952, then

all required schedules and attachments must be made available except

enter that person’s name and address below the name of the trust.

Part IV of Form 990-BL and Schedule A (Form 990-BL) as discussed

Include the suite, room, or other unit number after the street

above.

address. If the Post Office does not deliver mail to the street address

and the filer has a P.O. box, show the box number instead of the street

Inspection and requests for copies must be permitted during regular

address.

business hours at the organization’s principal office and at each of its

regional or district offices. This provision applies to any organization

“Return filed by”. Check only the box that applies to you.

that files Form 990-BL, regardless of the size of the organization and

1. Check the “Trust” box when the return is filed by a black lung

whether or not it has any paid employees. Also, copies must be

benefit trust as an information return, or tax return, or both.

provided the same business day they are requested unless unusual

2. Check the “Trustee” box when the return is filed by a trustee

circumstances exist. In the case of unusual circumstances the copies

because of liability for taxes under section 4951 or 4952, or both.

must be provided by the next business day after the day the unusual

3. Check the “Disqualified person” box when the return is filed by a

circumstances cease to exist, but in no event may the delay exceed five

disqualified person who is liable for section 4951 tax only.

business days. See Regulations section 301.6104(d)-1 for what

constitutes unusual circumstances and the definition of regional and

Taxpayer Identification Number. Enter the EIN of the black lung

district offices.

benefit trust. If the return is being filed by a trustee or disqualified

person, also enter that person’s SSN or EIN.

When a request for copies is made in writing, the copies must

Each trust should have only one employer identification number. If

generally be sent within 30 days of the date the request was received.

the trust has more than one number and has not been advised which

one to use, you should notify the Internal Revenue Service Center,

Note: A black lung benefit trust does not have to comply with

Attention: Entity Control, Stop 6273, Ogden, Utah 84201-0027. Inform

individual requests for copies if it makes this information widely

them what numbers the trust has; the name and address to which each

available. This can be done by posting the application for tax exemption

number was assigned; and the address of its principal office. The IRS

and/or an annual information return on a readily accessible World Wide

will then advise you which number to use.

Website. However, an organization that makes its information available

this way must advise requesters how the material may be accessed.

Application Pending, Address Change, and FMV of Assets. Fill in

See Regulations section 301.6104(d)-2 for specific instructions.

these blocks only when a return must be filed for a trust. Enter the fair

market value (FMV) of the trust’s assets at the beginning of the

Fee for copies. An organization may charge a reasonable fee for

operator’s tax year within which the trust’s tax year begins.

providing copies.

Signature. The return must be signed by the authorized trustee or

trustees and also by any person, firm, or corporation who prepared the

Before the organization provides the documents, it may require that

return. If the return is prepared by a firm or corporation, it should be

the individual requesting copies of the documents pay the fee. If the

signed in the name of the firm or corporation. The signature of the

organization has provided an individual making a request with notice of

preparer is not required if the return is prepared by a regular full-time

the fee, and the individual does not pay the fee within 30 days, or if the

employee of the filer.

individual pays the fee by check and the check does not clear upon

deposit, the organization may disregard the request.

The IRS is not authorized to redact the paid preparer’s social

security number if such SSN is entered in the paid preparer’s

Additional information. See Regulations sections 301.6104(d)-1

block. Because the Form 990-BL is a publicly disclosable

CAUTION

through 301.6104(d)-3 for additional information on reasonable fees for

document, any information entered in this block will be publicly

providing copies, not filling requests for copies when material is widely

disclosed (see Public Inspection of Completed 990-BL Returns and

available, and other related information.

Approve Exemption Applications). Accordingly, any paid preparer

whose identifying number must be listed on the Form 990-BL may wish

Exemption application. Any section 501(c)(21) organization that

to apply for and obtain a PTIN using Form W-7P, Application for

submitted an application for recognition of exemption to the IRS after

Preparer Tax Identification Number.

July 15, 1987, must make available for public inspection a copy of its

application (together with a copy of any papers submitted in support of

Part I—Analysis of Revenue and Expenses

its application) and any letter or other document issued by the IRS in

response to the application. An organization that submitted its

Line 1. Enter the total contributions received under section 192 from

exemption application on or before July 15, 1987, must also comply

the coal mine operator who established the trust.

with this requirement if it had a copy of its application on July 15, 1987.

Contributions to the trust must be in cash or property of the type in

As in the case of annual returns, the copy of the application and related

which the trust is permitted to invest (i.e., public debt securities of the

documents must be made available for inspection during regular

United States, obligations of a state or local government that are not in

business hours at the organization’s principal office and at each of its

default as to principal or interest, or time and demand deposits in a

regional or district offices having at least three employees.

bank or insured credit union as described in section 501(c)(21)(D)(ii)).

Penalties for Failure to Comply with Public Inspection

Line 2. Enter the amounts received during the year from the sources

Requirements. If a person does not comply with the requirement to

listed in 2a, b, c, and d.

permit public inspection of annual returns, there is a penalty of $20 for

Line 4. Enter the amounts contributed by the trust to the Federal Black

each day during which such failure continues, unless there is

Lung Disability Trust Fund as provided for by section 3(b)(3) of Public

reasonable cause. The maximum penalty imposed on all persons for

Law 95-227.

failures that apply to any one return is $10,000.

Line 5. Enter the amounts paid for insurance exclusively covering

liabilities under sections 501(c)(21)(A)(i)(I), 501(c)(21)(A)(i)(IV). For

If a person does not comply with the public inspection of applications

details see Regulations section 1.501(c)(21)-1(d).

requirement, there is a penalty of $20 a day for each day during which

such failure continues, unless there is reasonable cause. There is no

Line 6. Enter the amounts paid to or for the benefit of miners or their

maximum penalty limitation (see section 6652(c)).

beneficiaries other than amounts included in lines 4 or 5. Such

payments could include direct payment of medical bills, etc., authorized

Any person who willfully does not comply with the public inspection

by the Act and accident and health benefits for retired miners and their

requirements for the annual return or application is subject to an

spouses and dependents.

additional penalty of $5,000 for each return or application (see section

Line 7. Enter the total amount of compensation for the year of all

6685).

trustees. See Part III, line 26.

If more than one person is liable for any penalty, all such persons

Line 8. Enter the total of the salaries and wages of all employees other

shall be jointly and severally liable for each failure.

than those included in line 7.

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Instructions For Form 990-Bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons - Internal Revenue Service Page 2

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