Form 1094-B, Transmittal of Health Coverage Information Returns

Reporting of health insurance coverage

OMB: 1545-2252

IC ID: 205933

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Form 1094-B, Transmittal of Health Coverage Information Returns
 
No Modified
 
Voluntary
 
26 CFR 1.6055-1 26 CFR 1.6055-2

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 1094-B Transmittal of Health Coverage Information Returns f1094-b--2021-00-00.pdf Yes Yes Fillable Fileable
Instruction i1094-b_and_1095_b--2021-00-00.pdf Yes No Fillable Printable

General Government Taxation Management

; IRS 24.030- Individual Master File, IRS 24.046-Customer Account Data Engine Business Master File, and IRS 34.037- Audit Trail and Security Records System  80 FR 54064

30,000 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 30,000 0 0 0 0 30,000
Annual IC Time Burden (Hours) 5,000 0 0 0 0 5,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
REG-132455-11 - Reporting of Minimum Essential Coverage (NPRM) REG-132455-11.pdf 10/20/2017
TD 9660 TD 9660.pdf 10/20/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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