Form 8963, Report of Health Insurance Provider Information

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

Documents and Forms

Document Name Document Type
i8963--2020.pdf Instruction
i8963--2020.pdf Instruction
8963 Report of Health Insurance Provider Information Form 8963.docx Form
8963 Report of Health Insurance Provider Information Form 8963.docx Form

Information Collection (IC) Details

IC Title:	Form 8963, Report of Health Insurance Provider Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

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

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	17,808	17,808
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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