Form 13562, Health Coverage Tax Credit (HCTC) General Registration Information Form; Form 13929, Health Coverage Tax Credit (HCTC) Paper Check Request

Forms and Documents

Document Name	Status
Form 13562 Health Coverage Tax Credit (HCTC) Form and Instruction	New
ombat1.doc Supplementary Document	2008-05-21
Supporting statement.doc Supporting Statement A	2008-05-21

IC Document Collections

IC ID	Document Title	Status
185015	Health Coverage Tax Credit (HCTC) Form and Instruction	New

ICR Details

OMB Control No: 1545-2118	ICR Reference No: 200805-1545-017
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Form 13562, Health Coverage Tax Credit (HCTC) General Registration Information Form; Form 13929, Health Coverage Tax Credit (HCTC) Paper Check Request
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: 09/03/2008
	Date Received in OIRA: 07/30/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2011	36 Months From Approved
Responses	700	0	0
Time Burden (Hours)	875	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: These forms are used to help manage the HCTC program. Health plan administrators will use these forms to submit requests of; changes to their account information, waivers from the Federal requirement that mandates all payments to be made via Electronic Funds Transfer (EFT), and to provide the required registration information into the HCTC program.

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Authorizing Statute(s): US Code: 26 USC 7527 Name of Law: Advance payment of credit for health insurance costs of eligible individuals
   US Code: 26 USC 35 Name of Law: Health insurance costs of eligible individuals
  

Citations for New Statutory Requirements: PL: Pub.L. 107 - 210 201 Name of Law: Trade Act of 2002

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 15257	03/21/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 43976	07/29/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Health Coverage Tax Credit (HCTC)	HCTC, 13562, 13929	Health Coverage Tax Credit (HCTC) General Registration Information Form ,   Health Coverage Tax Credit (HCTC) Paper Check Request ,   Health Coverage Tax Credit (HCTC) Administrative Changes Form

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	700	0	0	700	0	0
Annual Time Burden (Hours)	875	0	0	875	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: Internal Revenue Code Sections 35 and 7527 enacted by public law 107-210, require the Internal Revenue Service to provide payments of the HCTC to eligible individuals beginning August 1, 2003. The IRS will use these forms to ensure, that the processes and communications for delivering these payments help taxpayers determine if they are eligible for the credit and understand what they need to do to continue to receive it.

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Annual Cost to Federal Government: $500

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

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/30/2008

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