Form 1095-B, Health Coverage

REG-132455-11 - Reporting of Minimum Essential Coverage (TD 9660 - final)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2252 can be found here:

Documents and Forms

Document Name Document Type
i1094-b_and_1095_b--2017-00-00.pdf Instruction
1095-B Health Coverage f1095-b--2017-00-Draft Form.pdf Form
REG-132455-11.pdf REG 132455-11 Reporting of Minimum Essential Coverage IC Document
TD 9660.pdf TD 9660 IC Document

Information Collection (IC) Details

IC Title:	Form 1095-B, Health Coverage	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			i1094-b_and_1095_b--2017-00-00.pdf		Yes	No	Fillable Printable
Form	1095-B	Health Coverage	f1095-b--2017-00-Draft Form.pdf		Yes	Yes	Fillable Fileable

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	125,000,000	120,400,000	4,600,000
Annual IC Time Burden (Hours)	2,083,333	1,997,333	86,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
REG 132455-11 Reporting of Minimum Essential Coverage	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.