Information Collection

Form 1094-B, Transmittal of Health Coverage Information Returns

IC 205933 under ICR 201710-1545-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 1094-B Form 1094-B, Transmittal of Health Coverage Information Returns	Form
i1094-b_and_1095_b--2017-00-00.pdf	Instruction
1094-B Transmittal of Health Coverage Information Returns f1094-b--2017-00-Draft Form.pdf	Form
REG-132455-11.pdf REG-132455-11 - Reporting of Minimum Essential Coverage (NPRM)	IC Document
TD 9660.pdf TD 9660	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Form 1094-B, Transmittal of Health Coverage Information Returns

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	1094-B	Transmittal of Health Coverage Information Returns	f1094-b--2017-00-Draft Form.pdf		Yes	Yes	Fillable Fileable
Instruction			i1094-b_and_1095_b--2017-00-00.pdf		Yes	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: ; IRS 24.030- Individual Master File, IRS 24.046-Customer Account Data Engine Business Master File, and IRS 34.037- Audit Trail and Security Records System

FR Citation: 80 FR 54064

Number of Respondents: 30,000

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30,000	29,570	430
Annual IC Time Burden (Hours)	5,000	4,928	72
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REG-132455-11 - Reporting of Minimum Essential Coverage (NPRM)	REG-132455-11.pdf	10/20/2017
TD 9660	TD 9660.pdf	10/20/2017

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