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OMB Control No:	ICR Reference No: 202604-1545-010
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Long-Term Care Premiums Paid Statement
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 07/01/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	7,500	0
Time Burden (Hours)	1,500	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to New Statute
Annual Number of Responses	7,500	7,500
Annual Time Burden (Hours)	1,500	1,500
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 collection due to enactment of Section 334 of the SECURE 2.0 Act.

Annual Cost to Federal Government: $16,416

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]? No

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: David Kabore 817 232-6356 david.n.kabore@irs.gov

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