Information Collection

TD 9724 - Summary of Benefits and Coverage Disclosures

IC 199118 under ICR 201810-1545-024 · OMB 1545-2229.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TD 9575.pdf TD 9575	IC Document
1545-2229 (TD 9724).pdf TD 9724	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2715

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

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,327,850

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	72,826,994	1,574,668	71,252,326
Annual IC Time Burden (Hours)	328,265	-103,288	431,553
Annual IC Cost Burden (Dollars)	7,040,366	-2,232,900	9,273,266

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
TD 9575	TD 9575.pdf	12/11/2014
TD 9724	1545-2229 (TD 9724).pdf	04/05/2016

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