HCTC - Family Member Eligibility Form (Form 14116)

Form 14116 - HCTC - Family Member Eligibility Form

OMB: 1545-2163

IC ID: 191172

Information Collection (IC) Details

View Information Collection (IC)

HCTC - Family Member Eligibility Form (Form 14116)
 
No New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 14116 Family Member Eligibility Form DRAFT-Form 14116 120909.pdf No   Paper Only

General Government Taxation Management

 

180 0
   
Individuals or Households
 
   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 180 180 0 0 0 0
Annual IC Time Burden (Hours) 30 30 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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