Information Collection

Form 1095-B, Health Coverage

IC 213670 under ICR 201403-1545-015 · OMB 1545-2252.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2252 can be found here:

Documents and Forms

Document Name Document Type
Instructions 1094B and 1095B (2014).pdf Instruction
1095-B Health Coverage Form 1095-B (verC-Cyc16).pdf Form
REG-132455-11.pdf REG 132455-11 Reporting of Minimum Essential Coverage 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: New

Obligation to Respond: Voluntary

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Instructions 1094B and 1095B (2014).pdf		Yes	No	Fillable Printable
Form	1095-B	Health Coverage	Form 1095-B (verC-Cyc16).pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 430	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	4,600,000	4,600,000
Annual IC Time Burden (Hours)	86,000	86,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
REG 132455-11 Reporting of Minimum Essential Coverage	REG-132455-11.pdf	10/29/2014
TD 9660	TD 9660.pdf	10/29/2014

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