Form 8965 - Reporting of Exemption From Coverage

REG-148500-12 - Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage (final)

Documents and Forms

Document Name Document Type
REG-148500-12.pdf REG-148500-12 IC Document

Information Collection (IC) Details

IC Title:	Form 8965 - Reporting of Exemption From Coverage	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 1.5000A-3

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	30,000,000	30,000,000
Annual IC Time Burden (Hours)	6,000,000	6,000,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
REG-148500-12	REG-148500-12.pdf	08/22/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.