Information Collection

Monthly HCTC (Health Coverage Tax Credit) Group Registration Form

IC 192496 under ICR 201004-1545-001 · OMB 1545-1842.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.