Instructions For Form 8930 - 2010 Page 3

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your 2010 return (including extensions)
Revenue laws of the United States. We
returns and return information are
generally will be reported on your 2011
need this information to ensure that you
confidential, as required by section 6103.
tax return. However, you may have to file
are complying with these laws and to
However, we may give this information to
an amended return in certain situations.
allow us to figure and collect the right
the Department of Justice for civil and
See Amending Form 8930 on page 2.
amount of tax. You are required to give us
criminal litigation, and to cities, states, the
this information if you made certain
District of Columbia, and U.S.
Do not include on line 16
contributions or received certain
commonwealths and possessions to carry
!
repayments of qualified disaster
distributions from qualified plans,
out their tax laws. We may also disclose
recovery assistance distributions
CAUTION
including IRAs, and other tax-favored
this information to other countries under a
made after 2009 that were included on
accounts. Our legal right to ask for the
tax treaty, to federal and state agencies to
your 2009 Form 8930.
information requested on this form is
enforce federal nontax criminal laws, or to
Example. You received a $90,000
sections 6001, 6011, 6012(a), and 6109
federal law enforcement and intelligence
qualified disaster recovery assistance
and their regulations. If you do not
agencies to combat terrorism.
distribution on October 1, 2009, from your
provide this information, or you provide
The average time and expenses
Roth IRA because of the severe storms in
incomplete or false information, you may
required to complete and file this form will
the Midwestern disaster areas. On April 1,
be subject to penalties.
vary depending on individual
2011, you repay $30,000 to your Roth
You are not required to provide the
circumstances. For the estimated
IRA. You file your return on April 10,
information requested on a form that is
averages, see the instructions for your
2011. Since the repayment was made
subject to the Paperwork Reduction Act
income tax return.
before you filed your return, and not later
unless the form displays a valid OMB
If you have suggestions for making this
than the due date (including extensions),
control number. Books or records relating
form simpler, we would be happy to hear
you would enter the $30,000 repayment
to a form or its instructions must be
from you. See the instructions for your
on line 16.
retained as long as their contents may
income tax return.
become material in the administration of
Privacy Act and Paperwork Reduction
any Internal Revenue law. Generally, tax
Act Notice. We ask for the information
on this form to carry out the Internal
-3-
Instructions for Form 8930 (2010)

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