OMB control number
Form 8453-R - Electronic Filing Declaration for Form 8963
OMB 1545-2253 · TREAS/IRS.
OMB 1545-2253
Use Form 8453-R to authenticate the electronic filing of Form 8963, Report of Health Insurance Provider Information.
The latest form for Form 8453-R - Electronic Filing Declaration for Form 8963 expires 2023-09-30 and is listed under ICR 202002-1545-003.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 8453-R Form 8453-R - Electronic Filing Declaration for Form 8963 | Form and Instruction |
 SUP STAT (Form 8453-R)_1545-2253_MS (N).docx | Supporting Statement A |
 Form 8453-R - Electronic Filing Declaration for Form 8963 |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202002-1545-003 | Extension without change of a currently approved collection | 2020-06-29 | Approved without change | |
| 201702-1545-012 | Extension without change of a currently approved collection | 2017-03-28 | Approved without change | |
| 201401-1545-018 | New collection (Request for a new OMB Control Number) | 2014-01-29 | Approved without change |