Notice of Rescission

Affordable Care Act Notice Relating to Rescissions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2180 can be found here:

Documents and Forms

Document Name Document Type
TD 9491.pdf TD 9491 IC Document
TD 9744.pdf TD 9744 IC Document

Information Collection (IC) Details

IC Title:	Notice of Rescission	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2712

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	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	1,533	1,533
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	250	250

Documents for IC

Title	Document	Date Uploaded
TD 9491	TD 9491.pdf	09/23/2020
TD 9744	TD 9744.pdf	09/23/2020

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