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Statement for Exempt Individuals and Individuals with a Medical Condition
Statement for Exempt Individuals and Individuals with a Medical Condition
OMB: 1545-1411
IC ID: 18264
OMB.report
TREAS/IRS
OMB 1545-1411
ICR 199609-1545-001
IC 18264
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1411 can be found here:
2002-08-14 - Extension without change of a currently approved collection
1999-08-13 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Statement for Exempt Individuals and Individuals with a Medical Condition
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
8843
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
150,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
150,000
0
0
0
0
150,000
Annual IC Time Burden (Hours)
172,845
0
360
0
0
172,485
Annual IC Cost Burden (Dollars)
0
0
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.