Information Collection

Health Coverage Tax Credit (HCTC)-Paper Check Request

IC 183161 under ICR 200712-1545-021 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13929 Health Coverage Tax Credit (HCTC)-Paper Check Request	Form
13929 Health Coverage Tax Credit (HCTC)-Paper Check Request 13929.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	13929	Health Coverage Tax Credit (HCTC)-Paper Check Request	13929.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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