Information Collection

Affordable Care Act Notice of Patient Protections

IC 193323 under ICR 201008-1545-022 · OMB 1545-2181.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2181 can be found here:

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IC Title:	Affordable Care Act Notice of Patient Protections	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2719AT

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 170,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	4,000,000	4,000,000
Annual IC Time Burden (Hours)	33,000	33,000
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.