View Information Collection (IC)

View Information Collection (IC)

IC Title:	Form 8941 - Credit for Small Employer Health Insurance Premiums	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			i8941_IRSWEB_2011_OMB2198.pdf		Yes	No	Printable Only
Other-Worksheets			Worksheets for Form 8941.pdf		Yes	No	Fillable Printable
Form	8941	Credit for Small Employer Health Insurance Premiums	f8941_IRSWEB_2011_OMB2198.pdf		Yes	Yes	Fillable Fileable

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: 4,000,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 95 %

	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	3,046,964	0	0	0	0	3,046,964
Annual IC Time Burden (Hours)	40,189,456	0	0	0	0	40,189,456
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Burden for Form 8941	f8941_Burden_2011_OMB2198.pdf	04/17/2011
Burden for worksheets	burden for worksheets of Form 8941.pdf	10/26/2010

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