Long-Term Care and Accelerated Death Benefits.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1519 can be found here:

Documents and Forms

Document Name Document Type
Form 1099-LTC Long-Term Care and Accelerated Death Benefits. Form
2012 Instructions Form 1099-LTC.pdf Instruction
1099-LTC Long-Term Care and Accelerated Death Benefits 2012 Form 1099-LTC.pdf Form
2011 Burden Special Business Form 1099-LTC.PDF 2011 Burden Form 1099-LTC IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Long-Term Care and Accelerated Death Benefits.	Agency IC Tracking Number:	jg-1519-013

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1099-LTC	Long-Term Care and Accelerated Death Benefits	2012 Form 1099-LTC.pdf		Yes	Yes	Fillable Fileable
Instruction			2012 Instructions Form 1099-LTC.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	79,047	79,047
Annual IC Time Burden (Hours)	18,181	18,181
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2011 Burden Form 1099-LTC	2011 Burden Special Business Form 1099-LTC.PDF	12/08/2011

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