Information Collection Request

Reporting of Health Insurance Coverage

ICR 202504-1545-006 · OMB 1545-2252 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1095-B Health Coverage Form Modified Available
Form 1095-B Form 1095-B, Health Coverage Form Modified Available
Form 1094-B Transmittal of Health Coverage Information Returns Form Modified Available
Form 1094-B Form 1094-B, Transmittal of Health Coverage Information Returns Form Modified Repair queued
1545-2252 Comment Matrix 2025_8-28-2025_FINAL.docx Supplementary Document Uploaded 2025-08-28 Available
1545-2252 Comment Matrix 2025_8-28-2025_FINAL.docx Supplementary Document Uploaded 2025-08-28 Repair queued
1545-2252 1095 PRA Comment Letter 6.11.25.pdf Public Comments Uploaded 2025-08-11 Available
Form 1095-B form comment.pdf Public Comments Uploaded 2025-07-02 Available
Supporting Statement 1545-2252.docx Supporting Statement A Uploaded 2025-08-11 Available
Supporting Statement 1545-2252.docx Supporting Statement A Uploaded 2025-08-11 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
213670 Form 1095-B, Health Coverage Form ModifiedHealth Coverage
213670 Form 1095-B, Health Coverage Form Modified
213670 Form 1095-B, Health Coverage Instruction Modified
205933 Form 1094-B, Transmittal of Health Coverage Information Returns Form ModifiedTransmittal of Health Coverage Information Returns
205933 Form 1094-B, Transmittal of Health Coverage Information Returns Form Modified
205933 Form 1094-B, Transmittal of Health Coverage Information Returns Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2028 36 Months From Approved 11/30/2025
211,755,000 0 125,030,000
3,572,000 0 2,088,333
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Form 1094-B, Transmittal of Health Coverage Information Returns 1094-B
Form 1095-B, Health Coverage 1095-B

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 211,755,000 125,030,000 0 0 86,725,000 0
Annual Time Burden (Hours) 3,572,000 2,088,333 0 0 1,483,667 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No