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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Patient Protection and Affordable Care Act Patient Protection Notice (TD 9951)	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:

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 %

	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

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.