IRS Form 1099-H "Health Coverage Tax Credit (Hctc) Advance Payments"

What is Form 1099-H?

IRS Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments, is a document released for those individuals who got payments during the calendar year of qualified health insurance payments for the benefit of eligible trade adjustment assistance. This form also covers alternative trade adjustment assistance, reemployment trade adjustment assistance, and Pension Benefit Guaranty Corporation payees.

The document is issued by the Internal Revenue Service (IRS) and was last revised in 2019 and is revised annually. A fillable 1099-H Form is available for download below. To see related 1099 forms follow the link here.

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IRS Form 1099-H Instructions

If an applicant has any difficulties while filling in the form, they should use the Official instructions for the 1099-H form developed by the IRS. It contains necessary explanations and examples, as well as provide information on penalties, corrected or void returns, statements to the recipients, etc.

The application is supposed to be filled in by issuers/providers of qualified health insurance coverage that obtained advance payments from the Department of the Treasury on behalf of eligible recipients. They must report those payments and provide information about payments to the recipient. For that purpose the application was developed in three copies:

  • Copy A - For the Internal Revenue Service Center;
  • Copy B - For the Recipient;
  • Copy C - For the Provides (Issuer).

Copy A of the form is supposed to be filed by the provider with the IRS electronically Before March 31, 2020.

All copies contain the same amount of information and are presented on one page each. The document is divided into several sections, which include:

  1. Information about the issuer/provider. This section includes certain data, such as issuer's / provider's name, full address (street address, town or city, state or province, country, zip code, and telephone number), their taxpayer identification number (TIN), which can be presented by a social security number, adoption taxpayer identification number, or individual taxpayer identification number.
  2. Information about the recipient. Here an applicant must enter the recipient's name, their full address (which by the analogy with the previous section must include street address, city or town, state or province, country, zip code, and telephone number), and their TIN as well.
  3. Information about payments. In the last part of the application, a filer must state the amount of HCTC advance payments of qualified health insurance costs that were made and designate the payments per month.
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Download IRS Form 1099-H "Health Coverage Tax Credit (Hctc) Advance Payments"

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VOID
CORRECTED
7171
ISSUER'S/PROVIDER'S name, street address, city or town, state or
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
province, country, ZIP or foreign postal code, and telephone no.
$
2019
Tax Credit (HCTC)
2 No. of mos. HCTC
payments received
Advance Payments
1099-H
Form
Copy A
3 Jan.
9 July
ISSUER'S/PROVIDER'S TIN
RECIPIENT'S TIN
For
$
$
Internal Revenue
RECIPIENT'S name
4 Feb.
10 Aug.
Service Center
$
$
5 Mar.
11 Sept.
$
$
For Privacy Act
and Paperwork
Street address (including apt. no.)
6 Apr.
12 Oct.
Reduction Act
$
$
Notice, see the
7 May
13 Nov.
City or town, state or province, country, and ZIP or foreign postal code
2019 General
$
$
Instructions for
Certain Information
8 June
14 Dec.
Returns.
$
$
1099-H
Form
Cat. No. 34912D
www.irs.gov/Form1099H
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
VOID
CORRECTED
7171
ISSUER'S/PROVIDER'S name, street address, city or town, state or
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
province, country, ZIP or foreign postal code, and telephone no.
$
2019
Tax Credit (HCTC)
2 No. of mos. HCTC
payments received
Advance Payments
1099-H
Form
Copy A
3 Jan.
9 July
ISSUER'S/PROVIDER'S TIN
RECIPIENT'S TIN
For
$
$
Internal Revenue
RECIPIENT'S name
4 Feb.
10 Aug.
Service Center
$
$
5 Mar.
11 Sept.
$
$
For Privacy Act
and Paperwork
Street address (including apt. no.)
6 Apr.
12 Oct.
Reduction Act
$
$
Notice, see the
7 May
13 Nov.
City or town, state or province, country, and ZIP or foreign postal code
2019 General
$
$
Instructions for
Certain Information
8 June
14 Dec.
Returns.
$
$
1099-H
Form
Cat. No. 34912D
www.irs.gov/Form1099H
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
CORRECTED (if checked)
ISSUER'S/PROVIDER'S name, street address, city or town, state or
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
province, country, ZIP or foreign postal code, and telephone no.
$
2019
Tax Credit (HCTC)
2 No. of mos. of HCTC advance
payments and reimbursement
Advance Payments
credits paid to you
1099-H
Form
3 Jan.
9 July
ISSUER'S/PROVIDER'S TIN
RECIPIENT'S TIN
$
$
Copy B
RECIPIENT'S name
4 Feb.
10 Aug.
$
$
For Recipient
5 Mar.
11 Sept.
This is important
$
$
tax information
Street address (including apt. no.)
6 Apr.
12 Oct.
and is being
$
$
furnished to the
IRS.
7 May
13 Nov.
City or town, state or province, country, and ZIP or foreign postal code
$
$
8 June
14 Dec.
$
$
1099-H
(keep for your records)
Form
www.irs.gov/Form1099H
Department of the Treasury - Internal Revenue Service
Instructions for Recipient
adoption taxpayer identification number (ATIN)).
This statement is provided to you because you received
However, the issuer has reported your complete TIN to
Health Coverage Tax Credit (HCTC) advance payments
the IRS.
of your health coverage insurance premiums. These
advance payments were forwarded directly to your
Box 1. Shows the total amount of HCTC advance
health insurance provider. You are qualified to receive
payments of qualified health insurance costs that were
advance payments if you were an eligible trade
made on your behalf.
adjustment assistance (TAA) recipient, an Alternative
Box 2. Shows the total number of months you received
TAA (ATAA) recipient, a Reemployment TAA (RTAA)
HCTC payments.
recipient, or a Pension Benefit Guaranty Corporation
Boxes 3 through 14. Shows the amount of HCTC
(PBGC) pension payee. See Form 8885, Health
advance payments paid for you for each month. The
Coverage Tax Credit, and its instructions for more
total of the amounts shown in these boxes equals the
details on qualified recipients and how to figure any
amount shown in box 1.
credit that you may be able to take on your Form 1040,
Future Developments
1040NR, 1040-SS, or 1040-PR.
For the latest information about developments related to
Recipient’s taxpayer identification number (TIN).
Form 1099-H and its instructions, such as legislation
For your protection, this form may show only the last
enacted after they were published, go to
four digits of your TIN (social security number (SSN),
www.irs.gov/Form1099H.
individual taxpayer identification number (ITIN), or
VOID
CORRECTED
ISSUER'S/PROVIDER'S name, street address, city or town, state or
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
province, country, ZIP or foreign postal code, and telephone no.
$
2019
Tax Credit (HCTC)
2 No. of mos. HCTC
payments received
Advance Payments
1099-H
Form
3 Jan.
9 July
ISSUER'S/PROVIDER'S TIN
RECIPIENT'S TIN
$
$
Copy C
RECIPIENT'S name
4 Feb.
10 Aug.
For
$
$
Issuer/Provider
5 Mar.
11 Sept.
For Privacy Act
$
$
and Paperwork
Reduction Act
Street address (including apt. no.)
6 Apr.
12 Oct.
Notice, see the
$
$
2019 General
7 May
13 Nov.
City or town, state or province, country, and ZIP or foreign postal code
Instructions for
$
$
Certain Information
Returns.
8 June
14 Dec.
$
$
1099-H
Form
www.irs.gov/Form1099H
Department of the Treasury - Internal Revenue Service
Instructions for Issuer/Provider
File Copy A of this form with the IRS electronically by
To complete Form 1099-H, use:
March 31, 2020. To file electronically, you must have
• The 2019 General Instructions for Certain Information
software that generates a file according to the
Returns, and
specifications in Pub. 1220.
• The 2019 Instructions for Form 1099-H.
Need help? If you have questions about reporting on
To order these instructions and additional forms, go to
Form 1099-H, call the information reporting customer
www.irs.gov/Form1099H.
service site toll free at 866-455-7438 or 304-263-8700
Due dates. Furnish Copy B of this form to the recipient
(not toll free). Persons with a hearing or speech
by January 31, 2020.
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).

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