View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1545-2152	ICR Reference No: 201707-1545-017
Status: Historical Active	Previous ICR Reference No: 201302-1545-006
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 14095--The Health Coverage Tax Credit (HCTC) Reimbursement Request Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 10/05/2017
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/18/2017
	Date Received in OIRA: 10/05/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	6 Months From Approved
Responses	3,058	0	0
Time Burden (Hours)	2,039	0	0
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	3,058	3,058
Annual Time Burden (Hours)	2,039	2,039
Annual Cost Burden (Dollars)	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Submission request for reinstatement. The Health Coverage Tax Credit (HCTC) was reauthorized into law June 29, 2015 and will remain in effect through December 31, 2019.

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Lynn Reno 2022839639

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.