Information Collection

Health Coverage Tax Credit (HCTC)

IC 185015 under ICR 201109-1545-016 · OMB 1545-2118.

Documents and Forms

Document Name Document Type
Form 13562 Health Coverage Tax Credit (HCTC) Form and Instruction
13562 Health Coverage Tax Credit (HCTC) General Registration I 13562.pdf Form and Instruction
13929 Health Coverage Tax Credit (HCTC) Paper Check Request 13929.pdf Form and Instruction
HCTC Health Coverage Tax Credit (HCTC) Administrative Changes HCTC Admin Chg Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Coverage Tax Credit (HCTC)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13562	Health Coverage Tax Credit (HCTC) General Registration Information Form	13562.pdf	Yes	No	Fillable Printable
Form and Instruction	13929	Health Coverage Tax Credit (HCTC) Paper Check Request	13929.pdf	Yes	No	Fillable Printable
Form	HCTC	Health Coverage Tax Credit (HCTC) Administrative Changes Form	HCTC Admin Chg Form.pdf	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	875	875
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.