Form 8963, Report of Health Insurance Provider Information

REG-118315-12 (FINAL), Health Insurance Providers Fee and Form 8963, Report of Health Insurance Provider Information

OMB: 1545-2249

IC ID: 210140

Information Collection (IC) Details

View Information Collection (IC)

Form 8963, Report of Health Insurance Provider Information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form 8963 Report of Health Insurance Provider Information f8963--2016-02-00.pdf Yes Yes Fillable Fileable
Instruction i8963--2016-02-00.pdf Yes No Printable Only

General Government Taxation Management

 

2,400 0
   
Private Sector Not-for-profit institutions, 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 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 17,808 0 0 0 0 17,808
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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