View Information Collection (IC)

View Information Collection (IC)

IC Title:	TD 9575 - Summary of Benefits and Coverage and the Uniform Glossary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2715

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 858	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	79,699,998	0	0	0	0	79,699,998
Annual IC Time Burden (Hours)	649,500	0	0	0	0	649,500
Annual IC Cost Burden (Dollars)	5,035,021	0	0	0	0	5,035,021

Documents for IC

Title	Document	Date Uploaded
REG140038-10	REG-140038-10.pdf	09/02/2011
Notice 2011	Notice 2011-.pdf	09/02/2011
TD 9575	TD 9575.pdf	12/11/2014

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