Form 1095-B, Health Coverage

Reporting of health insurance coverage

OMB: 1545-2252

IC ID: 213670

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
Form
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Form 1095-B, Health Coverage
 
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
Instruction i1094-b_and_1095_b--2021-00-00.pdf Yes No Fillable Printable
Form 1095-B Health Coverage f1095-b--2021-00-00.pdf Yes Yes Fillable Fileable

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
 
   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 125,000,000 0 0 0 0 125,000,000
Annual IC Time Burden (Hours) 2,083,333 0 0 0 0 2,083,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
REG 132455-11 Reporting of Minimum Essential Coverage 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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