REG-118315-12 - Health Insurance Providers Fee and Form 8963, Report of Health Insurance Provider Information

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8963 Report of Health Insurance Provider Information	Form	Modified	Available
SUP STAT (Form 8963) (1545-2249).docx	Supporting Statement A	Uploaded 2020-11-20	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210140	Form 8963, Report of Health Insurance Provider Information	Form	Modified	Report of Health Insurance Provider Information
210140	Form 8963, Report of Health Insurance Provider Information	Instruction	Modified
207129	REG-118315-12 (FINAL), Health Insurance Providers Fee		Unchanged

ICR Details

OMB Control No: 1545-2249	ICR Reference No: 202009-1545-010
Status: Historical Active	Previous ICR Reference No: 201705-1545-002
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: REG-118315-12 - Health Insurance Providers Fee and Form 8963, Report of Health Insurance Provider Information
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/28/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/27/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	36 Months From Approved	01/31/2021
Responses	3,200	0	3,200
Time Burden (Hours)	18,208	0	18,208
Cost Burden (Dollars)	0	0	0

---

Abstract: The Affordable Care Act imposes an annual fee on health insurance providers that provide health insurance for United States health risks (a covered entity). IRS final regulations, which implements the Affordable Care Act, describe how the IRS will administer the health insurance providers fee. This information collection covered under this request are the recordkeeping requirements prescribed in §57.2(e)(2) that each member of a controlled group are to maintain records of consent to the controlled group's selection of the designated entity. Reporting requirements under §57.3 will be reported through Form 8963, "Report of Health Insurance Provider Information". File Form 8963, Report of Health Insurance Provider Information, to report net premiums written for health insurance of United States health risks. The information reported will be used by the IRS to calculate the annual fee on health insurance providers.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 9010 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 111 - 152 1406 Name of Law: Health Care and Eduction Reconciliation Act of 2010.
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 51849	08/22/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 75414	11/25/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Form 8963, Report of Health Insurance Provider Information	8963	Report of Health Insurance Provider Information
REG-118315-12 (FINAL), Health Insurance Providers Fee

---

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	3,200	3,200	0	0	0	0
Annual Time Burden (Hours)	18,208	18,208	0	0	0	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:

---

Annual Cost to Federal Government: $16,403

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.     No

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.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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? No

---

Common Form ICR:  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:

(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: 11/27/2020

---