Information Collection

Form 8941 - Credit for Small Employer Health Insurance Premiums

IC 195017 under ICR 201104-1545-007 · OMB 1545-2198.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2198 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
i8941_IRSWEB_2011_OMB2198.pdf	Instruction
Worksheets for Form 8941.pdf	Other-Worksheets
8941 Credit for Small Employer Health Insurance Premiums f8941_IRSWEB_2011_OMB2198.pdf	Form
f8941_Burden_2011_OMB2198.pdf Burden for Form 8941	IC Document
burden for worksheets of Form 8941.pdf Burden for worksheets	IC Document

IC Title:

Form 8941 - Credit for Small Employer Health Insurance Premiums

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			i8941_IRSWEB_2011_OMB2198.pdf	Yes	No	Printable Only
Other-Worksheets			Worksheets for Form 8941.pdf	Yes	No	Fillable Printable
Form	8941	Credit for Small Employer Health Insurance Premiums	f8941_IRSWEB_2011_OMB2198.pdf	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,046,964	3,046,964
Annual IC Time Burden (Hours)	40,189,456	40,189,456
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden for Form 8941	f8941_Burden_2011_OMB2198.pdf	04/17/2011
Burden for worksheets	burden for worksheets of Form 8941.pdf	10/26/2010

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