Information Collection

TD 9575 - Summary of Benefits and Coverage and the Uniform Glossary

IC 199118 under ICR 201409-1545-021 · OMB 1545-2229.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2229 can be found here:

Documents and Forms

Document Name Document Type
REG-140038-10.pdf REG140038-10 IC Document
Notice 2011-.pdf Notice 2011 IC Document
TD 9575.pdf TD 9575 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TD 9575 - Summary of Benefits and Coverage and the Uniform Glossary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2715

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 858	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	79,699,998	79,699,998
Annual IC Time Burden (Hours)	649,500	649,500
Annual IC Cost Burden (Dollars)	5,035,021	5,035,021

Documents for IC

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