Form 1095-C

Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans

Documents and Forms

Document Name Document Type
Form Form 1095-C Form 1095-C Form
2023 Instructions for Forms 1094-C and 1095-C.pdf Instruction
2023 Instructions for Forms 1094-C and 1095-C.pdf Instruction
Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2023 Form 1095-C.pdf Form
Form 1095-C Employer-Provided Health Insurance Offer and Coverage 2023 Form 1095-C.pdf Form

Information Collection (IC) Details

IC Title:	Form 1095-C	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 301.6056-2 26 CFR 301.6056-1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 1095-C	Employer-Provided Health Insurance Offer and Coverage	2023 Form 1095-C.pdf		Yes	Yes	Fillable Fileable
Instruction			2023 Instructions for Forms 1094-C and 1095-C.pdf		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: IRS 24.046-Customer Account Data Engine Business Master File	FR Citation: 80 FR 54064

Number of Respondents: 122,644,376	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	122,644,376	17,644,376	105,000,000
Annual IC Time Burden (Hours)	24,528,875	3,528,875	21,000,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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