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Proposed Collection; Comment Request for HCTC Program Forms

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Internal Revenue Service (IRS), Treasury.


Notice and request for comments.


The Department of the Treasury, as part of its continuing effort to reduce paperwork and respondent burden, invites the general public and other Federal agencies to take this opportunity to comment on proposed and/or continuing information collections, as required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 13865, Health Coverage Tax Credit (HCTC) Paper Check Request and Form 13929, Health Coverage Tax Credit (HCTC) Administrative Change Form.


Written comments should be received on or before May 31, 2011 to be assured of consideration.


Direct all written comments to Yvette Lawrence, Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224.

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Requests for additional information or copies of the form and instructions should be directed to Ralph Terry, (202) 622-8144, at Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224, or through the Internet at

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Title: Health Coverage Tax Credit (HCTC)—Paper Check Request, Health Coverage Tax Credit (HCTC)—Administrative Change Form.

OMB Number: 1545-2118.

Form Number: Form 13928, and Form 13865.

Abstract: These forms are used to help manage the HCTC program. Health plan administrators will use these forms to submit requests of; changes to their account information, waivers from the Federal requirement that mandates all payments to be made via Electronic Funds Transfer (EFT), and to provide the required registration information into the HCTC program.

Current Actions: There are changes in the paperwork burden previously approved by OMB and also being submitted for renewal.

Type of Review: Extension of a currently approved collection.

Affected Public: Businesses and other for-profit organizations, Farms.

Estimated Number of Respondents: 700.

Estimated Time per Respondent: 35 minutes.

Estimated Total Annual Burden Hours: 410.

The following paragraph applies to all of the collections of information covered by this notice:

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless the collection of information displays a valid OMB control number. Books or records relating to a collection of information must be retained as long as their contents may become material in the administration of any internal revenue law. Generally, tax returns and tax return information are confidential, as required by 26 U.S.C. 6103.

Request for Comments: Comments submitted in response to this notice will be summarized and/or included in the request for OMB approval. All Start Printed Page 18302comments will become a matter of public record. Comments are invited on: (a) Whether the collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (b) the accuracy of the agency's estimate of the burden of the collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology; and (e) estimates of capital or start-up costs and costs of operation, maintenance, and purchase of services to provide information.

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Approved: March 25, 2011.

Yvette Lawrence,

IRS Reports Clearance Officer.

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[FR Doc. 2011-7669 Filed 3-31-11; 8:45 am]