View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1545-2253	ICR Reference No: 201401-1545-018
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 8453-R - Declaration and Signature for Electronic Filing of Forms 8947 and 8963
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/07/2014
	Date Received in OIRA: 01/29/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	2,550	0	0
Time Burden (Hours)	4,131	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to New Statute
Annual Number of Responses	2,550	2,550
Annual Time Burden (Hours)	4,131	4,131
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new form established under Section 9010 of the Patient Protection and Affordable Care Act (PPACA), Public Law No. 111-148 (124 Stat. 119 (2010)), as amended by section 10905 of PPACA, and as further amended by section 1406 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152 (124 Stat. 1029 (2010) , which requires any covered entity engaged in the business of providing health insurance related to United States health risks must annually report its net premiums. The purpose of the form is a declaration signed by the electronic reports officer to authenticate the electronic filing of Form 8947, Report of Branded Prescription Drug Information and Form 8963, Report of Health Insurance Provider Information. The creation of this new form will increase taxpayer burden by 4,131 hours.

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