Information Collection

Form 8941 - Credit for Small Employer Health Insurance Premiums

IC 195017 under ICR 201311-1545-036 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 8941 Form 8941 - Credit for Small Employer Health Insurance Premiums	Form
2013 Instructions 8941.pdf	Instruction
8941 Credit for Small Employer Health Insurance Premiums Form 8941.pdf	Form
burden_for_worksheets_of_Form_8941.pdf Burden for Worksheets	IC Document
brdn_busi.pdf Burden for Form	IC Document
REG-113792-13.pdf REG-113792-13	IC Document
Notice 2010-44.pdf Notice 2010-44	IC Document
Notice 2010-82.pdf Notice 2010-82	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8941	Credit for Small Employer Health Insurance Premiums	Form 8941.pdf		Yes	Yes	Fillable Fileable
Instruction			2013 Instructions 8941.pdf		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,046,964

Number of Respondents for Small Entity: 3,046,964

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,046,964	0	3,046,964
Annual IC Time Burden (Hours)	34,278,346	-5,911,110	40,189,456
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Burden for Worksheets	burden_for_worksheets_of_Form_8941.pdf	05/16/2014
Burden for Form	brdn_busi.pdf	11/21/2013
REG-113792-13	REG-113792-13.pdf	05/16/2014
Notice 2010-44	Notice 2010-44.pdf	05/16/2014
Notice 2010-82	Notice 2010-82.pdf	05/16/2014

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