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Federal forms, ICRs, and supporting documents

Information Collection

Form 8963, Report of Health Insurance Provider Information

IC 210140 under ICR 202009-1545-010 · OMB 1545-2249.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Form 8963, Report of Health Insurance Provider Information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction i8963--2020.pdf Yes No Printable Only
Form 8963 Report of Health Insurance Provider Information Form 8963.docx Yes Yes Fillable Fileable

General Government Taxation Management

 

2,400 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 17,808 0 0 0 0 17,808
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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