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Affordable Care Act Notice of Patient Protections
REG-120399-10 - Affordable Care Act Notice of Patient Protections
OMB: 1545-2181
IC ID: 193323
OMB.report
TREAS/IRS
OMB 1545-2181
ICR 201011-1545-040
IC 193323
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2181 can be found here:
2022-06-29 - Extension without change of a currently approved collection
2021-12-01 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Affordable Care Act Notice of Patient Protections
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
Federal Enterprise Architecture Business Reference Module
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
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
4,000,000
0
0
0
0
4,000,000
Annual IC Time Burden (Hours)
33,000
0
0
0
0
33,000
Annual IC Cost Burden (Dollars)
0
0
0
0
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.