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

Forms and Documents

Document Name	Status
Form 4423 Form 4423 Form and Instruction	Modified
Form Form 1095-C Form 1095-C Form	Modified
Form Form 1094-C Form 1094-C Form	Modified
ICR 1545-2251 Form 194-C, 1095-C and 4423 Summary Burden 2018.pdf Supplementary Document	2018-02-28
2018-02-28_SS_1545-2251r.doc Supporting Statement A	2018-02-28

IC Document Collections

IC ID	Document Title	Status
214083	Form 4423 Form and Instruction	Modified
214082	Form 1095-C Form	Modified
210443	Form 1094-C Form	Modified

ICR Details

OMB Control No: 1545-2251	ICR Reference No: 201801-1545-022
Status: Active	Previous ICR Reference No: 201701-1545-021
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/04/2018
	Date Received in OIRA: 02/14/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	105,400,006	0	3,865,006
Time Burden (Hours)	22,600,002	0	810,002
Cost Burden (Dollars)	0	0	0

---

Abstract: This document contains previously approved regulations providing guidance to employers that are subject to the information reporting requirements under section 6056 of the Internal Revenue Code, enacted by the Patient Protection and Affordable Care Act (P.L. 111-148 (124 Stat.119 (2010)). Section 6056 requires those employers to report to the IRS information about their compliance with the employer shared responsibility provisions of section 4980H of the Code and about the health care coverage, if any, they have offered employees. Section 6056 also requires those employers to furnish related statements to employees in order that employees may use the statements to help determine whether, for each month of the calendar year, they can claim on their tax returns a premium tax credit under section 36B of the Code (premium tax credit).

---

Authorizing Statute(s): US Code: 26 USC 4980H Name of Law: Tax on reversion of qualified plan assets to employer
   US Code: 26 USC 6056 Name of Law: Information and Returns, Information Regading Health Insurance Coverage
  

Citations for New Statutory Requirements: US Code: 26 USC 6056 Name of Law: Information and Returns, Information Regading Health Insurance Coverage

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 50732	11/01/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 6732	02/14/2018
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Form 1095-C	Form 1095-C	Employer-Provided Health Insurance Offer and Coverage
Form 4423	4423	Application for Filing Affordable Care Act (ACA) Information Returns
Form 1094-C	Form 1094-C	Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	105,400,006	3,865,006	0	0	101,535,000	0
Annual Time Burden (Hours)	22,600,002	810,002	0	0	21,790,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change to this existing regulation. However, the agency has updated the number of respondents to reflect the most recent data available.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/14/2018

---