OMB control number
The Health Coverage Tax Credit (HCTC) Reimbursement Request Form
OMB 1545-2152 · TREAS/IRS.
OMB 1545-2152
This form will be used by HCTC participants to request reimbursement for health plan premiums paid prior to the commencement of advance payments.
The latest form for The Health Coverage Tax Credit (HCTC) Reimbursement Request Form expires 2022-02-28 and is listed under ICR 201802-1545-011.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 14095 The Health Coverage Tax Credit (HCTC) Reimbursement Request Form | Form and Instruction |
 SS 1545-2152_2021.docx | Supporting Statement A |
 The Health Coverage Tax Credit (HCTC) Reimbursement Request Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202111-1545-022 | Revision of a currently approved collection | 2022-02-28 | Approved without change | |
| 201802-1545-011 | Extension without change of a currently approved collection | 2018-06-27 | Approved without change | |
| 201707-1545-017 | Reinstatement without change of a previously approved collection | 2017-10-05 | Approved without change | |
| 201302-1545-006 | Extension without change of a currently approved collection | 2013-03-28 | Approved without change | |
| 201002-1545-017 | Extension without change of a currently approved collection | 2010-02-25 | Approved without change | |
| 200908-1545-006 | New collection (Request for a new OMB Control Number) | 2009-08-10 | Approved without change |