OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Form 13562, Health Coverage Tax Credit (HCTC) General Registration Information Form; Form 13929, Health Coverage Tax Credit (HCTC) Paper Check Request

ICR 201109-1545-016 · OMB 1545-2118 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 13562 Health Coverage Tax Credit (HCTC) Form and Instruction Modified Available
ombat1.doc Supplementary Document Uploaded 2008-05-21 Available
2118 SS.doc Supporting Statement A Uploaded 2011-09-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
185015 Health Coverage Tax Credit (HCTC) Form and Instruction Modified
ICR Details
1545-2118 201109-1545-016
Historical Active 200805-1545-017
TREAS/IRS ah-2118-016
Form 13562, Health Coverage Tax Credit (HCTC) General Registration Information Form; Form 13929, Health Coverage Tax Credit (HCTC) Paper Check Request
Extension without change of a currently approved collection   No
Regular
Approved without change 11/04/2011
Retrieve Notice of Action (NOA) 09/29/2011
  Inventory as of this Action Requested Previously Approved
11/30/2014 36 Months From Approved 11/30/2011
700 0 700
875 0 875
0 0 0
These forms are used to help manage the HCTC program. Health plan administrators will use these forms to submit requests of; changes to their account information, waivers from the Federal requirement that mandates all payments to be made via Electronic Funds Transfer (EFT), and to provide the required registration information into the HCTC program.
US Code: 26 USC 7527 Name of Law: Advance payment of credit for health insurance costs of eligible individuals
   US Code: 26 USC 35 Name of Law: Health insurance costs of eligible individuals
  
None
Not associated with rulemaking
  76 FR 18301 04/01/2011
76 FR 60127 09/28/2011
No
  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 700 700 0 0 0 0
Annual Time Burden (Hours) 875 875 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$500
No
No
No
No
No
Uncollected
Lynn Reno 2022839639
  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.
09/29/2011