Form 1094-C

Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans

OMB: 1545-2251

IC ID: 210443

Information Collection (IC) Details

View Information Collection (IC)

Form 1094-C
 
No Modified
 
Voluntary
 
26 CFR 301.6011-9 26 CFR 301.6056-1 26 CFR 301.6056-2

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns f1094-c--2016-00-00.pdf www.IRS.gov Yes Yes Fillable Fileable
Instruction i1094-c_and_1095_c--2016-00-00.pdf www.IRS.gov Yes Yes Fillable Printable

General Government Taxation Management

 

15,000 0
   
Private Sector Businesses or other for-profits
 
   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 15,000 0 0 0 0 15,000
Annual IC Time Burden (Hours) 60,000 0 0 0 0 60,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Notice 2011-36 Notice 2011-36.pdf 02/21/2014
Notice 2011-73 Notice 2011-73.pdf 02/21/2014
Notice 2012-17 Notice 2012-17.pdf 02/21/2014
Notice 2012-58 Notice 2012-58.pdf 02/21/2014
REG-138006-12 REG-136630-12 NPRM.pdf 02/21/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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