Health Coverage Tax Credit (HCTC) Monthly Registration and Update

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 13441-A Health Coverage Tax Credit (HCTC) Monthly Registration and Update	Form and Instruction	Modified	Available
2019-07-25_SS_1545-1842rSC.doc	Supporting Statement A	Uploaded 2019-08-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
41159	Health Coverage Tax Credit (HCTC) Monthly Registration and Update	Form and Instruction	Modified
192496	Monthly HCTC (Health Coverage Tax Credit) Group Registration Form		Removed

ICR Details

OMB Control No: 1545-1842	ICR Reference No: 201906-1545-011
Status: Active	Previous ICR Reference No: 201604-1545-005
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Health Coverage Tax Credit (HCTC) Monthly Registration and Update
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: 10/10/2019
	Date Received in OIRA: 08/29/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	5,146	0	5,400
Time Burden (Hours)	2,573	0	1,800
Cost Burden (Dollars)	0	0	0

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Abstract: Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update Form will be directly mailed to all individuals who are potentially eligible for the HCTC. Potentially eligible individuals will use this form to determine if they are eligible for the Health Coverage Tax Credit and to register for the HCTC program. Participation in this program is voluntary. This form will be submitted by the individual to the HCTC program office in a postage-paid, return envelope. We will accept faxed forms, if necessary. Additionally, recipients may call the HCTC call center for help in completing this form.

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Authorizing Statute(s): PL: Pub.L. 114 - 27 407 stat 363 Name of Law: Trade Preferences Extension Act Of 2015
   US Code: 26 USC 35 Name of Law: Health insurance costs of eligible individuals
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 25337	05/31/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 45212	08/29/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Monthly HCTC (Health Coverage Tax Credit) Group Registration Form
Health Coverage Tax Credit (HCTC) Monthly Registration and Update	13441-A	Health Coverage Tax Credit (HCTC) Monthly Registration and Update

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ICR Summary of Burden

table that charts list 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	5,146	5,400	0	0	-254	0
Annual Time Burden (Hours)	2,573	1,800	0	0	773	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: Changes in burden are due to decrease in estimated filers of (254) and the increase in burden hours of 773 due to the consolidation of the two previous obsolete Forms 13441 and 13441-EZ to current Form 13441-A, which resulted in the overall burden hours of 2,573.

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Annual Cost to Federal Government: $65,000

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]? No

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

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Common Form ICR:  No

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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: 08/29/2019

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