Information Collection

Health Coverage Tax Credit Registration Update Form

IC 19678 under ICR 200903-1545-015 · OMB 1545-1954.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1954 can be found here:

Documents and Forms

Document Name Document Type
Form 13704 Health Coverage Tax Credit Registration Update Form Form and Instruction
13704 Monthly HCTC Registration Update Form 40924j07.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Coverage Tax Credit Registration Update Form	Agency IC Tracking Number:	ah-1954-015

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13704	Monthly HCTC Registration Update Form	40924j07.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,100	1,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.