Information Collection

Gen IC: Health Coverage Tax Credit (HCTC) for Eligible Trade Adjustment Assistance (TAA), Alternative TAA (ATAA) and Reemployment TAA (RTAA) Recipients

IC 223861 under ICR 201601-1225-005 · OMB 1225-0086.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0086 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
1225-0086 UIPL_HCTC Final.doc	Other-UIPL Program Letter
1225-0086 UIPL_HCTC AttachmentA Final.doc	Other-UIPL HCTC Attachment A
1225-0086 UIPL_HCTC_AttachmentB Final.doc	Other-UIPL HCTC Attachment B
1225-0086 HCTC UIPL Supplemental Support Statement.docx Supporting Statement: Health Coverage Tax Credit (HCTC) for Eligible Trade Adjustment Assistance (TAA), Alternative TAA (ATAA) a	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Gen IC: Health Coverage Tax Credit (HCTC) for Eligible Trade Adjustment Assistance (TAA), Alternative TAA (ATAA) and Reemployment TAA (RTAA) Recipients

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-UIPL Program Letter	1225-0086 UIPL_HCTC Final.doc	Yes	Yes	Fillable Fileable
Other-UIPL HCTC Attachment A	1225-0086 UIPL_HCTC AttachmentA Final.doc	Yes	Yes	Fillable Fileable
Other-UIPL HCTC Attachment B	1225-0086 UIPL_HCTC_AttachmentB Final.doc	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	1,080	1,080
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement: Health Coverage Tax Credit (HCTC) for Eligible Trade Adjustment Assistance (TAA), Alternative TAA (ATAA) and Reemployment TAA (RTAA) Recipients	1225-0086 HCTC UIPL Supplemental Support Statement.docx	10/07/2016

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