ICR 202504-1545-006

OMB: 1545-2252

Federal Form Document

Forms and Documents

Document Name	Status
Form 1095-B Form 1095-B, Health Coverage Form	Modified
Form 1094-B Form 1094-B, Transmittal of Health Coverage Information Returns Form	Modified
1545-2252 Comment Matrix 2025_8-28-2025_FINAL.docx Supplementary Document	2025-08-28
Supporting Statement 1545-2252.docx Supporting Statement A	2025-08-11

IC Document Collections

IC ID	Document Title	Status
213670	Form 1095-B, Health Coverage Form	Modified
205933	Form 1094-B, Transmittal of Health Coverage Information Returns Form	Modified