State Election of Qualified Health Insurance for Health Coverage Tax Credit (HCTC)

ICR 202104-1545-004

OMB: 1545-1875

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2021-05-28
IC Document Collections
IC ID
Document
Title
Status
19545
Unchanged
ICR Details
1545-1875 202104-1545-004
Received in OIRA 202001-1545-011
TREAS/IRS
State Election of Qualified Health Insurance for Health Coverage Tax Credit (HCTC)
Extension without change of a currently approved collection   No
Regular 05/28/2021
  Requested Previously Approved
36 Months From Approved 05/31/2021
51 51
26 26
0 0

Revenue Procedure 2004-12 informs states how to elect a health program to be qualified health insurance for purposes of the health coverage tax credit (HCTC) under section 35 of the Internal Revenue Code. The collection of information is voluntary. However, if a state does not make an election, eligible residents of the state may be impeded in their efforts to claim the HCTC.

US Code: 26 USC 35 Name of Law: Health Insurance Costs of Eligible Individuals
  
None

Not associated with rulemaking

  86 FR 18373 04/08/2021
86 FR 28683 05/27/2021
No

1
IC Title Form No. Form Name
Health Insurance Costs of Eligible Individuals

  Total Request 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 51 51 0 0 0 0
Annual Time Burden (Hours) 26 26 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    No
No
No
No
No
Paul Adams 737 800-6149

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/28/2021


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