Health Insurance Premium Tax Credit

Forms and Documents

Document Name	Status
Form 1095-A Form 1095-A- Health Insurance Marketplace Statement Form	New
1545-2232- Supporting Statement.docx Supporting Statement A	2014-12-12

IC Document Collections

IC ID	Document Title	Status
213666	Form 1095-A- Health Insurance Marketplace Statement Form	New
198353	TD 9590 (REG-131491-10) Health Insurance Premium Tax Credit	Removed

ICR Details

OMB Control No: 1545-2232	ICR Reference No: 201410-1545-025
Status: Historical Active	Previous ICR Reference No: 201305-1545-029
Agency/Subagency: TREAS/IRS	Agency Tracking No:
Title: Health Insurance Premium Tax Credit
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/12/2014
	Date Received in OIRA: 11/12/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	04/30/2017
Responses	2,000,000	0	15
Time Burden (Hours)	11,250	0	10,050
Cost Burden (Dollars)	0	0	0

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Abstract: This document contains final regulations relating to the health insurance premium assistance credit enacted by the Patient Protection and Affordable Care Act (PPACA). The regulations provide guidance to individuals who claim the premium assistance credit and exchanges that make qualified health plans available to individuals and employers. The IRS developed Form 1095-A under the authority of ICR section 36B(f)(3) for individuals to compute the amount of premium tax credit and file an accurate tax return.

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Authorizing Statute(s): US Code: 26 USC 36B Name of Law: Premium assistance credit
   PL: Pub.L. 111 - 148 1411, 1412 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: US Code: 26 USC 36B Name of Law: Premium assistance credit

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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:
	79 FR 52118	09/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 66766	11/10/2014
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
Form 1095-A- Health Insurance Marketplace Statement	1095-A	Health Insurance Marketplace Statement
TD 9590 (REG-131491-10) Health Insurance Premium Tax Credit

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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	2,000,000	15	0	-15	2,000,000	0
Annual Time Burden (Hours)	11,250	10,050	0	-10,050	11,250	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: Requesting OMB approval to add Form 1095-A under this currently approved OMB number. The IRS developed Form 1095-A under the authority of ICR section 36B(f)(3) for individuals to compute the amount of premium tax credit and file an accurate tax return. Due to the creation of this form, IRS has adjusted the burden estimate to 11,250 hours.

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Annual Cost to Federal Government: $0

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]? 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? 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: 11/12/2014

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