REG-125592-10 (TD 9494), Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.

REG-125592-10 (TD 9494), Affordable Care Act Internal Claims and Appeals and External review Disclosures.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2182 can be found here:

Documents and Forms

Document Name Document Type
REG-125592-10 (TD 9494).rtf TD 9494 IC Document

Information Collection (IC) Details

IC Title:	REG-125592-10 (TD 9494), Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2719T

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,769,264	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	278,412	216,412	62,000
Annual IC Time Burden (Hours)	2,271	1,921	350
Annual IC Cost Burden (Dollars)	1,143,236	1,143,236	0

Documents for IC

Title	Document	Date Uploaded
TD 9494	REG-125592-10 (TD 9494).rtf	02/11/2014

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