Information Collection

Credit for Small Employer Health Insurance Premiums

IC 195017 under ICR 202009-1545-008 · OMB 1545-2198.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2198 can be found here:

Documents and Forms

Document Name Document Type
i8941--2019-00-00.pdf Instruction
i8941--2019-00-00.pdf Instruction
circ_21i8941_20200723192500.pdf Instruction
circ_21i8941_20200723192500.pdf Instruction
8941 Credit for Small Employer Health Insurance Premiums f8941--2019-00-00.pdf Form
8941 Credit for Small Employer Health Insurance Premiums f8941--2019-00-00.pdf Form
8941 Credit for Small Employer Health Insurance Premiums wrn_20f8941_20200402151410.pdf Form
8941 Credit for Small Employer Health Insurance Premiums wrn_20f8941_20200402151410.pdf Form
REG-113792-13.pdf REG-113792-13 IC Document
REG-113792-13.pdf REG-113792-13 IC Document
Notice 2010-44.pdf Notice 2010-44 IC Document
Notice 2010-44.pdf Notice 2010-44 IC Document
Notice 2010-82.pdf Notice 2010-82 IC Document
Notice 2010-82.pdf Notice 2010-82 IC Document
TD 9672.pdf TD 9672 IC Document
TD 9672.pdf TD 9672 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Credit for Small Employer Health Insurance Premiums	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	8941	Credit for Small Employer Health Insurance Premiums	f8941--2019-00-00.pdf	Yes	Yes	Fillable Fileable
Instruction			i8941--2019-00-00.pdf	Yes	No	Printable Only
Form	8941	Credit for Small Employer Health Insurance Premiums	wrn_20f8941_20200402151410.pdf	Yes	Yes	Fillable Fileable
Instruction			circ_21i8941_20200723192500.pdf	Yes	No	Printable Only

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 181,000	Number of Respondents for Small Entity: 181,000

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

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	181,000	-2,865,964	3,046,964
Annual IC Time Burden (Hours)	2,036,250	-32,242,096	34,278,346
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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