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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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.