Form 1095-C

Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans

OMB: 1545-2251

IC ID: 214082

Information Collection (IC) Details

View Information Collection (IC)

Form 1095-C
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form 1095-C Employer-Provided Health Insurance Offer and Coverage f1095-c--2020-00-00.pdf www.irs.gov Yes Yes Fillable Fileable
Instruction i109495c.pdf www.irs.gov Yes Yes Fillable Fileable

Health Health Care Services

IRS 24.046-Customer Account Data Engine Business Master File  80 FR 54064

105,000,000 0
   
Private Sector Businesses or other for-profits
 
   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 105,000,000 0 0 0 0 105,000,000
Annual IC Time Burden (Hours) 21,000,000 0 0 0 0 21,000,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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