Information Collection

Health Coverage Tax Credit (HCTC)

IC 185015 under ICR 200805-1545-017 · OMB 1545-2118.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2118 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13562 Health Coverage Tax Credit (HCTC)	Form and Instruction
13562 Health Coverage Tax Credit (HCTC) General Registration I 13562.pdf	Form and Instruction
13929 Health Coverage Tax Credit (HCTC) Paper Check Request 13929.pdf	Form and Instruction
HCTC Health Coverage Tax Credit (HCTC) Administrative Changes HCTC Admin Chg Form.pdf	Form

IC Title:

Health Coverage Tax Credit (HCTC)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13562	Health Coverage Tax Credit (HCTC) General Registration Information Form	13562.pdf	Yes	No	Fillable Printable
Form and Instruction	13929	Health Coverage Tax Credit (HCTC) Paper Check Request	13929.pdf	Yes	No	Fillable Printable
Form	HCTC	Health Coverage Tax Credit (HCTC) Administrative Changes 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: 700

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	875	875
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.