Information Collection

Statement For Recipients Of Medical And Health Care Payments

IC 128578 under ICR 198108-1545-048 · OMB 1545-0114.

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Information Collection (IC) Details

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IC Title:	STATEMENT FOR RECIPIENTS OF MEDICAL AND HEALTH CARE PAYMENTS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1099 MED				No	No
Form	1087 MED				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,100,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,100,000	569,423	-5,423	4,536,000
Annual IC Time Burden (Hours)	442,000	-52,500	500	494,000
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.