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: 1545-2182	ICR Reference No: 202102-1545-021
Status: Historical Active	Previous ICR Reference No: 201711-1545-025
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Affordable Care Act Internal Claims and Appeals and External review Disclosures.
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/14/2021
	Date Received in OIRA: 04/30/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved	07/31/2021
Responses	278,412	0	278,412
Time Burden (Hours)	2,271	0	2,271
Cost Burden (Dollars)	1,143,236	0	1,143,236

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	278,412	278,412
Annual Time Burden (Hours)	2,271	2,271
Annual Cost Burden (Dollars)	1,143,236	1,143,236

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:

Annual Cost to Federal Government: $26,000

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. No

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. No

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)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Karen Levin 202 622-6080 karen.levin@irscounsel.treas.gov

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