Information Collection

Patient Protection and Affordable Care Act Patient Protection Notice (TD 9951)

IC 193323 under ICR 202204-1545-012 · OMB 1545-2181.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
TD 9951 (7-13-21)2021-14379 (6).pdf Patient Protection and Affordable Care Act Patient Protection Notice	IC Document
TD 9951 (7-13-21)2021-14379 (6).pdf Patient Protection and Affordable Care Act Patient Protection Notice	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9822-1T

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

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,241

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: 58 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	148,181	20,048	128,133
Annual IC Time Burden (Hours)	2,810	-724	3,534
Annual IC Cost Burden (Dollars)	7,409	5,807	1,602

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Patient Protection and Affordable Care Act Patient Protection Notice	TD 9951 (7-13-21)2021-14379 (6).pdf	06/15/2022

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