Information Collection

Form 1095-B, Health Coverage

IC 213670 under ICR 201403-1545-015 · OMB 1545-2252.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2252 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instructions 1094B and 1095B (2014).pdf	Instruction
1095-B Health Coverage Form 1095-B (verC-Cyc16).pdf	Form
REG-132455-11.pdf REG 132455-11 Reporting of Minimum Essential Coverage	IC Document
TD 9660.pdf TD 9660	IC Document

IC Title:

Form 1095-B, Health Coverage

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 1.6055-1 26 CFR 1.6055-2

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
Instruction			Instructions 1094B and 1095B (2014).pdf		Yes	No	Fillable Printable
Form	1095-B	Health Coverage	Form 1095-B (verC-Cyc16).pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 430

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	4,600,000	4,600,000
Annual IC Time Burden (Hours)	86,000	86,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REG 132455-11 Reporting of Minimum Essential Coverage	REG-132455-11.pdf	10/29/2014
TD 9660	TD 9660.pdf	10/29/2014

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