Information Collection

Health Coverage Tax Credit (HCTC)-Administrative Change Form

IC 183164 under ICR 200712-1545-021 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form HCTC Admin Chg For Health Coverage Tax Credit (HCTC)-Administrative Change Form	Form
HCTC Admin Chg For Health Coverage Tax Credit (HCTC)-Administrative Change HCTC Admin Chg Form.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	HCTC Admin Chg Form	Health Coverage Tax Credit (HCTC)-Administrative Change Form	HCTC Admin Chg Form.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)	37	37
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.