Information Collection

Form 1095-B, Health Coverage

IC 213670 under ICR 202504-1545-006 · OMB 1545-2252.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1095-B Form 1095-B, Health Coverage	Form
Form 1095-B Health Coverage Form 1095-B, Health Coverage	Form
Instructions for Form 1094-B and 1095-B rev 2024.pdf	Instruction
Instructions for Form 1094-B and 1095-B rev 2024.pdf	Instruction
1095-B Health Coverage f1095-b--2025-00-00.pdf	Form
1095-B Health Coverage f1095-b--2025-00-00.pdf	Form
REG-132455-11.pdf REG 132455-11 Reporting of Minimum Essential Coverage	IC Document
REG-132455-11.pdf REG 132455-11 Reporting of Minimum Essential Coverage	IC Document
TD 9660.pdf TD 9660	IC Document
TD 9660.pdf TD 9660	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Form 1095-B, Health Coverage

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 1.6055-2 26 CFR 1.6055-1

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
Form	1095-B				Yes	No	Fillable Fileable
Instruction					Yes	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records

Title: ; IRS 24.030- Individual Master File, IRS 24.046-Customer Account Data Engine Business Master File, and IRS 34.037- Audit Trail and Security Records System

FR Citation: 80 FR 54064

Number of Respondents: 285,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	211,470,000	86,470,000	125,000,000
Annual IC Time Burden (Hours)	3,524,500	1,441,167	2,083,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REG 132455-11 Reporting of Minimum Essential Coverage		10/20/2017
TD 9660		10/20/2017

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

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