Monthly HCTC (Health Coverage Tax Credit) Group Registration Form

Health Coverage Tax Credit Registration Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1842 can be found here:

Documents and Forms

Document Name Document Type
Form 13441-EZ Monthly HCTC (Health Coverage Tax Credit) Group Registration Form Form and Instruction
13441-EZ Monthly HCTC (Health Coverage Tax Credit) Group Registra Draft-Monthly HCTC Group Registration Form.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Monthly HCTC (Health Coverage Tax Credit) Group Registration Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 4980

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13441-EZ	Monthly HCTC (Health Coverage Tax Credit) Group Registration Form	Draft-Monthly HCTC Group Registration Form.doc		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	900	900
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.