Health Insurance Costs of Eligible Individuals for (HCTC)

ICR 202001-1545-011

OMB: 1545-1875

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2020-03-31
Supporting Statement A
2020-01-15
IC Document Collections
IC ID
Document
Title
Status
19545
Modified
ICR Details
1545-1875 202001-1545-011
Active 201612-1545-024
TREAS/IRS
Health Insurance Costs of Eligible Individuals for (HCTC)
Extension without change of a currently approved collection   No
Regular
Approved without change 05/18/2020
Retrieve Notice of Action (NOA) 03/31/2020
This OMB # is extended for 1 year on the understanding that Treasury will submit a discontinue request shortly due to the inclusion of this burden in under OMB # 1545-0074.
  Inventory as of this Action Requested Previously Approved
05/31/2021 36 Months From Approved 05/31/2020
51 0 51
26 0 26
0 0 0

Revenue Procedure 2004-12 informs states how to elect a health program to be qualified health insurance for purposes of the health coverage tax credit (HCTC) under section 35 of the Internal Revenue Code. The collection of information is voluntary. However, if a state does not make an election, eligible residents of the state may be impeded in their efforts to claim the HCTC.

US Code: 26 USC 35 Name of Law: Health Insurance Costs of Eligible Individuals
  
None

Not associated with rulemaking

  84 FR 66706 12/05/2019
85 FR 17951 03/31/2020
No

1
IC Title Form No. Form Name
Health Insurance Costs of Eligible Individuals

  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 51 51 0 0 0 0
Annual Time Burden (Hours) 26 26 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    No
No
No
No
No
Shareen Pflanz 202 622-4920 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/31/2020


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