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Revenue Procedure 2004-12, Health Insurance Costs of Eligible Individuals
Revenue Procedure 2004-12, Health Insurance Costs of Eligible Individuals
OMB: 1545-1875
IC ID: 19545
OMB.report
TREAS/IRS
OMB 1545-1875
ICR 201308-1545-074
IC 19545
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1875 can be found here:
2021-05-28 - Extension without change of a currently approved collection
2020-03-31 - Extension without change of a currently 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:
Revenue Procedure 2004-12, Health Insurance Costs of Eligible Individuals
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
26 CFR 6103
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:
51
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
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
51
0
0
0
0
51
Annual IC Time Burden (Hours)
26
0
0
0
0
26
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.