Federal Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate

Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate
Form 8038-T (Rev. October 2021)
Form

8038-T

(Rev. October 2021)
Department of the Treasury
Internal Revenue Service

Part I

Arbitrage Rebate, Yield Reduction
and Penalty in Lieu of Arbitrage Rebate

▶

OMB No. 1545-0047

Under sections 143(g)(3) and 148(f) and section 103(c)(6)(D) of the Internal Revenue Code of 1954.
▶ Go to www.irs.gov/Form8038T for instructions and the latest information.

Reporting Authority

Check box if Amended Return ▶

1

Issuer’s name

2

Issuer’s employer identification number (EIN)

3

Number and street (or P.O. box no. if mail is not delivered to street address)

4

Report number (For IRS Use Only)

5

City, town, or post office, state, and ZIP code

6

Date of issue

7

Name of issue

8

CUSIP number

9

Name and title of officer of the issuer or other person whom the IRS may call for more information

10

11

Type of issue ▶

Issue price ▶

12
13
14
15

Computation date to which this payment relates (MM/DD/YYYY) . . . . .
Arbitrage rebate payment (see instructions)
check box if less than 100% of rebate amount . . .
Yield reduction payment (see instructions)
check box if less than 100% of yield reduction amount
Rebate payment from Qualified Zone Academy Bond (QZAB) defeasance escrow (see instructions) . .

Room/suite

7

Part II

Part III

11

Arbitrage Rebate and Yield Reduction Payments

Number of months since date of issue:

17
18
19

6 mos
12 mos
18 mos
Penalty in lieu of rebate . . . . . . .
Date of termination election (MM/DD/YYYY) .
Penalty upon termination
. . . . . .

.
.
.

24 mos
. . .
. . .
. . .

.
.
.

.
.
.

.
.
.

Other. No. of mos ▶
. . . . . . .
. .
. . . . . . .

15

.

.

.

17

.

.

.

19

Late Payments

20

Does failure to pay timely qualify for waiver of penalty? See instructions .

.

.

21
22

Penalty for failure to pay on time (see instructions)
Interest on underpayment (see instructions) . .

.
.

.
.

.
.

.
.

.
.

.
.

.
.

.
.

.
.

.
.

21
22

Total payment. Add lines 13, 14, 15, 17, 19, 21, and 22. Enter total here

.

.

.

.

.

.

.

.

.

23

.

.

.

.

.

.

.

.

.

24

Part V
23

Part VI

.
.

.
.

.
.

.
.

.
.

.
.

Yes

No

Total Payment
Miscellaneous

24

Unspent proceeds as of this computation date

25
26

Proceeds used to redeem bonds . . . . . . . . . . . . . . . . . . . . .
Gross proceeds used for qualified administrative costs for guaranteed investment contracts (GICs) and
defeasance escrows . . . . . . . . . . . . . . . . . . . . . . . . .

25

27

Fees paid for a qualified guarantee .

27

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Amount

13
14

Penalty in Lieu of Arbitrage Rebate

16

Part IV

Telephone number of officer or other person

.

.

.

.

26

.

Yes
28

Is the issue a variable rate issue?

29

Did the issuer enter into a hedge?

30

Were gross proceeds invested in a GIC?

31
32

Were any gross proceeds invested beyond an available temporary period? . . . .
Calculations for filing of this form prepared by:
Issuer
Preparer:

.

.

.

. . . . . .
Name of provider
Term of hedge
Name of provider

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

28

.

29

Term of GIC

Signature of issuer’s authorized representative

Print/Type preparer’s name

Date

Preparer’s signature

▲

Paid
Preparer
Use Only

30
.

.

.

.

.

.

.

.

.

31

.

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessary to
process this return, to the person that I have authorized above.
▲

Signature
and
Consent

No

Type or print name and title
Date

Check
if
self-employed

Firm’s name

▶

Firm’s EIN

Firm’s address

▶

Phone no.

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11545Y

PTIN

▶

Form 8038-T (Rev. 10-2021)