Information Collection

Grandfathered Plan Change in Carrier Disclosure

IC 263884 under ICR 202312-1545-010 · OMB 1545-2178.

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Information Collection (IC) Details

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IC Title:	Grandfathered Plan Change in Carrier Disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9831 29 CFR 2590.732 26 CFR 54.9815-1251T 45 CFR 146.145

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: 39,311	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 38 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	39,311	39,311
Annual IC Time Burden (Hours)	655	655
Annual IC Cost Burden (Dollars)	125,533	125,533

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