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Self-Certification or Notification to HHS
Coverage of Certain Preventive Services Under the Affordable Care Act - Private Sector
OMB: 1545-2307
IC ID: 256647
OMB.report
TREAS/IRS
OMB 1545-2307
ICR 202210-1545-017
IC 256647
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Self-Certification or Notification to HHS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
26 CFR 26 CFR 54.9815-2713(a)(1)(iv)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Taxation Management
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
2
2
0
0
0
0
Annual IC Time Burden (Hours)
2
2
0
0
0
0
Annual IC Cost Burden (Dollars)
1
1
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.