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Computation Of Excess Hospital Insurance Benefits Tax
COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX
OMB: 1545-0171
IC ID: 129044
OMB.report
TREAS/IRS
OMB 1545-0171
ICR 198208-1545-027
IC 129044
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-0171 can be found here:
1990-06-27 - Revision of a currently approved collection
1989-09-08 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
COMPUTATION OF EXCESS HOSPITAL INSURANCE BENEFITS TAX
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
4469
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,000
0
0
0
0
1,000
Annual IC Time Burden (Hours)
1,000
0
0
0
0
1,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.