Information Collection

Health Coverage Tax Credit Registration Update Form

IC 19678 under ICR 201205-1545-009 · OMB 1545-1954.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1954 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 13704 Monthly HCTC Registration Update Form Health Coverage Tax Credit Registration Update Form	Form and Instruction
13704 Monthly HCTC Registration Update Form 2011 13704.pdf	Form and Instruction

IC Title:

Health Coverage Tax Credit Registration Update Form

Agency IC Tracking Number:

ah-1954-015

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	13704				Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	1,100	1,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].