TD 9724 - Summary of Benefits and Coverage Disclosures

Documents and Forms

Document Name Document Type
TD 9575.pdf TD 9575 IC Document
1545-2229 (TD 9724).pdf TD 9724 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	TD 9724 - Summary of Benefits and Coverage Disclosures	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:

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 %

	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

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.