Information Collection

Form 1094-B, Transmittal of Health Coverage Information Returns

IC 205933 under ICR 202203-1545-011 · OMB 1545-2252.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2252 can be found here:

2025-08-29 - Extension without change of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1094-B Form 1094-B, Transmittal of Health Coverage Information Returns	Form
i1094-b_and_1095_b--2021-00-00.pdf	Instruction
i1094-b_and_1095_b--2021-00-00.pdf	Instruction
1094-B Transmittal of Health Coverage Information Returns f1094-b--2021-00-00.pdf	Form
1094-B Transmittal of Health Coverage Information Returns f1094-b--2021-00-00.pdf	Form
REG-132455-11.pdf REG-132455-11 - Reporting of Minimum Essential Coverage (NPRM)	IC Document
REG-132455-11.pdf REG-132455-11 - Reporting of Minimum Essential Coverage (NPRM)	IC Document
TD 9660.pdf TD 9660	IC Document
TD 9660.pdf TD 9660	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Form 1094-B, Transmittal of Health Coverage Information Returns

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 26 CFR 1.6055-1 26 CFR 1.6055-2

Information Collection Instruments:

table that charts list of instruments
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

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: ; 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

FR Citation: 80 FR 54064

Number of Respondents: 30,000

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: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	5,000	5,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.