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Federal forms, ICRs, and supporting documents

Information Collection Request

STATEMENT FOR RECIPIENTS OF MEDICAL AND HEALTH CARE PAYMENTS

ICR 198104-1545-114 · OMB 1545-0114 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
128577 STATEMENT FOR RECIPIENTS OF MEDICAL AND HEALTH CARE PAYMENTS Form Migrated
ICR Details
1545-0114 198104-1545-114
Historical Active
TREAS/IRS
STATEMENT FOR RECIPIENTS OF MEDICAL AND HEALTH CARE PAYMENTS
Revision of a currently approved collection   No
Regular
Approved without change 04/01/1981
Retrieve Notice of Action (NOA) 04/01/1981
  Inventory as of this Action Requested Previously Approved
12/31/1981 12/31/1981
4,536,000 0 0
494,000 0 0
0 0 0
USED TO REPORT PAYMENTS TOTALING $600 OR MORE DURING THE YEAR TO A PHYSICIAN OR OTHER SUPPLIER OR PROVIDER OF SERVICES UNDER HEALTH, ACCIDENT, AND SICKNESS INSURANCE PLANS OR MEDICAL ASSISTANCE PROGRAMS (IRC SECTION 6041). THE INFORMATION IS USED BY IRS TO VERIFY REPORTING COMPLIANCE ON THE PART OF THE RECIPIENT.
None
None
No
1
IC Title Form No. Form Name
STATEMENT FOR RECIPIENTS OF MEDICAL AND HEALTH CARE PAYMENTS 1099-MED
  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 4,536,000 0 0 0 4,536,000 0
Annual Time Burden (Hours) 494,000 0 0 0 494,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/01/1981