Form Ttb F 5640.1 - Offer In Compromise - 2011 Page 5

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PAPERWORK REDUCTION ACT
This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is for respondents
to complete when they are found to have committed a violation of the IRC statutes and seek, through an offer in compromise,
to settle the case.
The estimated average burden associated with this collection is 2 hours per respondent or recordkeeper, depending on individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed
to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau,
Washington, D.C. 20220.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current,
valid OMB control number.
PUBLIC DISCLOSURE
Please note that the law requires that all accepted offers in compromise be available for review by the general public. Therefore, it is
possible that the details of this offer may become publicly known.
This information is used to ensure compliance by taxpayers with P.L. 100-203, Revenue Act of 1987, P.L. 100-647, Technical
Corrections Act of 1988, and the Internal Revenue laws of the United States. TTB uses the information to determine and collect the
right amount of tax.
PRIVACY ACT INFORMATION
The following information is provided pursuant to Section 3 of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)):
1. AUTHORITY. Solicitation of this information is made pursuant to 26 U.S.C. 7122(a). Disclosure of this information by the proponent
is voluntary.
2. PURPOSE. To enable TTB to evaluate and act upon the proponent’s proposal for an offer in compromise.
3. ROUTINE USES. The information will be used by TTB to make the determination set forth in paragraph 2. In addition, the information
may be disclosed to other Federal, State, foreign, and local law enforcement and regulatory agency personnel to verify information on
the form where such a disclosure is not prohibited by law. The information may further be disclosed to the Justice Department if it
appears that the furnishing of false information may constitute a violation of Federal law. Finally, the information may be disclosed to
members of the public when authorized by statute or regulations.
4. EFFECT OF NOT SUPPLYING INFORMATION REQUESTED. Failure to supply complete information may prevent TTB from making
an informed judgement regarding the consideration of the proposed offer.
Disclosure of the individual’s social security number is voluntary. Under 26 U.S.C. 7122, TTB has the authority to solicit this information.
The social security number may be used to verify the individual’s identity.
TTB F 5640.1 (02/2008)
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