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Proposed Information Collection; Comment Request

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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 1095-A, Health Insurance Marketplace Statement.


Written comments should be received on or before November 3, 2014 to be assured of consideration.


Direct all written comments to Stacey Becker, Internal Revenue Service, Room 6526, 1111 Constitution Avenue NW., Washington, DC 20224.

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Requests for additional information, or copies of the information collection and instructions should be addressed to Christie Preston, at Internal Revenue Service, Room 6129, 1111 Constitution Avenue NW., Washington, DC 20224, or through the Internet, at

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Title: Form 1095-A, Health Insurance Marketplace Statement.

OMB Number: 1545-2232.

Form Numbers: 1095-A.

Abstract: The IRS developed Form 1095-A under the authority of ICR section 36B(f)(3) for individuals to compute the amount of premium tax credit to which they are entitled under the Patient Protection and Affordable Care Act, Public Law 111-148, as amended, and file an accurate tax return. Marketplaces also must report certain information monthly to the IRS about individuals who receive from the Marketplace a certificate of exemption from the individual shared responsibility provision.

Current Actions: Requesting OMB approval to add Form 1095-A under this currently approved OMB number.

Type of Review: Revision to a currently approved collection.

Affected Public: State, local, or tribal government.

Estimated Number of Responses: 2,000,000.

Estimated Time Per Response: .3 minutes.

Estimated Total Annual Burden Hours: 11,250.

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 comments 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 agency's functions, including whether the information has 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 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: August 27, 2014.

Stacey Becker,

Director, Tax Forms and Publications Division.

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[FR Doc. 2014-20804 Filed 8-28-14; 4:15 pm]