IRS Form 8962 2018 Premium Tax Credit (Ptc)

IRS Form 8962 is a U.S. Department of the Treasury - Internal Revenue Service - issued form also known as the "Premium Tax Credit (ptc)".

A PDF of the latest IRS Form 8962 can be downloaded below or found on the U.S. Department of the Treasury - Internal Revenue Service Forms and Publications website.

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8962
OMB No. 1545-0074
Premium Tax Credit (PTC)
2018
Form
Attach to Form 1040 or Form 1040NR.
Attachment
Department of the Treasury
73
Go to www.irs.gov/Form8962 for instructions and the latest information.
Sequence No.
Internal Revenue Service
Name shown on your return
Your social security number
You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception (see instructions). If you qualify, check the box
.
.
Part I
Annual and Monthly Contribution Amount
1
Tax family size. Enter your tax family size (see instructions) .
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1
2a
Modified AGI. Enter your modified AGI (see instructions)
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2a
b
Enter the total of your dependents’ modified AGI (see instructions)
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2b
3
3
Household income. Add the amounts on lines 2a and 2b (see instructions) .
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4
Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3 (see instructions). Check the
appropriate box for the federal poverty table used.
a
Alaska
b
Hawaii
c
Other 48 states and DC
4
5
5
Household income as a percentage of federal poverty line (see instructions)
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%
6
Did you enter 401% on line 5? (See instructions if you entered less than 100%.)
No. Continue to line 7.
Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for
how to report your excess advance PTC repayment amount.
7
Applicable Figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions
.
.
7
Annual contribution amount. Multiply line 3 by
b Monthly contribution amount. Divide line 8a
8 a
8a
8b
line 7. Round to nearest whole dollar amount
by 12. Round to nearest whole dollar amount
Part II
Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9
Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage (see instructions)?
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage.
No. Continue to line 10.
10
See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23
No. Continue to lines 12–23. Compute
and continue to line 24.
your monthly PTC and continue to line 24.
(b) Annual applicable
(d) Annual maximum
(a) Annual enrollment
(c) Annual
(e) Annual premium tax
(f) Annual advance
Annual
SLCSP premium
premium assistance
premiums (Form(s)
contribution amount
credit allowed
payment of PTC (Form(s)
Calculation
(Form(s) 1095-A,
(subtract (c) from (b), if
1095-A, line 33C)
1095-A, line 33A)
(line 8a)
(smaller of (a) or (d))
line 33B)
zero or less, enter -0-)
11
Annual Totals
(c) Monthly
(a) Monthly enrollment
(b) Monthly applicable
(d) Monthly maximum
(f) Monthly advance
(e) Monthly premium tax
contribution amount
Monthly
premiums (Form(s)
SLCSP premium
premium assistance
payment of PTC (Form(s)
(amount from line 8b
credit allowed
Calculation
1095-A, lines 21–32,
(Form(s) 1095-A, lines
(subtract (c) from (b), if
1095-A, lines 21–32,
or alternative marriage
(smaller of (a) or (d))
column A)
21–32, column B)
zero or less, enter -0-)
column C)
monthly calculation)
12
January
13
February
14
March
15
April
16
May
17
June
18
July
19
August
20
September
21
October
22
November
23
December
24
Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here
24
25
Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here
25
Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
26
on Schedule 5 (Form 1040), line 70, or Form 1040NR, line 65. If line 24 equals line 25, enter -0-. Stop here. If line
25 is greater than line 24, leave this line blank and continue to line 27
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26
Part III
Repayment of Excess Advance Payment of the Premium Tax Credit
27
27
Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here
28
Repayment limitation (see instructions)
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28
Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
29
29
(Form 1040), line 46, or Form 1040NR, line 44
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.
8962
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2018)
Cat. No. 37784Z
8962
OMB No. 1545-0074
Premium Tax Credit (PTC)
2018
Form
Attach to Form 1040 or Form 1040NR.
Attachment
Department of the Treasury
73
Go to www.irs.gov/Form8962 for instructions and the latest information.
Sequence No.
Internal Revenue Service
Name shown on your return
Your social security number
You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception (see instructions). If you qualify, check the box
.
.
Part I
Annual and Monthly Contribution Amount
1
Tax family size. Enter your tax family size (see instructions) .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1
2a
Modified AGI. Enter your modified AGI (see instructions)
.
.
.
.
.
.
.
.
.
2a
b
Enter the total of your dependents’ modified AGI (see instructions)
.
.
.
.
.
.
2b
3
3
Household income. Add the amounts on lines 2a and 2b (see instructions) .
.
.
.
.
.
.
.
.
.
.
.
4
Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3 (see instructions). Check the
appropriate box for the federal poverty table used.
a
Alaska
b
Hawaii
c
Other 48 states and DC
4
5
5
Household income as a percentage of federal poverty line (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
%
6
Did you enter 401% on line 5? (See instructions if you entered less than 100%.)
No. Continue to line 7.
Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for
how to report your excess advance PTC repayment amount.
7
Applicable Figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions
.
.
7
Annual contribution amount. Multiply line 3 by
b Monthly contribution amount. Divide line 8a
8 a
8a
8b
line 7. Round to nearest whole dollar amount
by 12. Round to nearest whole dollar amount
Part II
Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit
9
Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage (see instructions)?
Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage.
No. Continue to line 10.
10
See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23
No. Continue to lines 12–23. Compute
and continue to line 24.
your monthly PTC and continue to line 24.
(b) Annual applicable
(d) Annual maximum
(a) Annual enrollment
(c) Annual
(e) Annual premium tax
(f) Annual advance
Annual
SLCSP premium
premium assistance
premiums (Form(s)
contribution amount
credit allowed
payment of PTC (Form(s)
Calculation
(Form(s) 1095-A,
(subtract (c) from (b), if
1095-A, line 33C)
1095-A, line 33A)
(line 8a)
(smaller of (a) or (d))
line 33B)
zero or less, enter -0-)
11
Annual Totals
(c) Monthly
(a) Monthly enrollment
(b) Monthly applicable
(d) Monthly maximum
(f) Monthly advance
(e) Monthly premium tax
contribution amount
Monthly
premiums (Form(s)
SLCSP premium
premium assistance
payment of PTC (Form(s)
(amount from line 8b
credit allowed
Calculation
1095-A, lines 21–32,
(Form(s) 1095-A, lines
(subtract (c) from (b), if
1095-A, lines 21–32,
or alternative marriage
(smaller of (a) or (d))
column A)
21–32, column B)
zero or less, enter -0-)
column C)
monthly calculation)
12
January
13
February
14
March
15
April
16
May
17
June
18
July
19
August
20
September
21
October
22
November
23
December
24
Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here
24
25
Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here
25
Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
26
on Schedule 5 (Form 1040), line 70, or Form 1040NR, line 65. If line 24 equals line 25, enter -0-. Stop here. If line
25 is greater than line 24, leave this line blank and continue to line 27
.
.
.
.
.
.
.
.
.
.
.
.
.
26
Part III
Repayment of Excess Advance Payment of the Premium Tax Credit
27
27
Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here
28
Repayment limitation (see instructions)
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
28
Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
29
29
(Form 1040), line 46, or Form 1040NR, line 44
.
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.
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.
8962
For Paperwork Reduction Act Notice, see your tax return instructions.
Form
(2018)
Cat. No. 37784Z
2
Form 8962 (2018)
Page
Part IV
Allocation of Policy Amounts
Complete the following information for up to four policy amount allocations. See instructions for allocation details.
Allocation 1
(a) Policy Number (Form 1095-A, line 2)
(b) SSN of other taxpayer
(c) Allocation start month
(d) Allocation stop month
30
(g) Advance Payment of the PTC
Allocation percentage
(e) Premium Percentage
(f) SLCSP Percentage
Percentage
applied to monthly
amounts
Allocation 2
(a) Policy Number (Form 1095-A, line 2)
(b) SSN of other taxpayer
(c) Allocation start month
(d) Allocation stop month
31
(g) Advance Payment of the PTC
Allocation percentage
(e) Premium Percentage
(f) SLCSP Percentage
Percentage
applied to monthly
amounts
Allocation 3
(a) Policy Number (Form 1095-A, line 2)
(b) SSN of other taxpayer
(c) Allocation start month
(d) Allocation stop month
32
(g) Advance Payment of the PTC
Allocation percentage
(e) Premium Percentage
(f) SLCSP Percentage
Percentage
applied to monthly
amounts
Allocation 4
(a) Policy Number (Form 1095-A, line 2)
(b) SSN of other taxpayer
(c) Allocation start month
(d) Allocation stop month
33
(g) Advance Payment of the PTC
Allocation percentage
(e) Premium Percentage
(f) SLCSP Percentage
Percentage
applied to monthly
amounts
34
Have you completed all policy amount allocations?
Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-
allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on
lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.
No. See the instructions to report additional policy amount allocations.
Part V
Alternative Calculation for Year of Marriage
Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.
To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.
(a) Alternative family size (b) Alternative monthly
(c) Alternative start month
(d) Alternative stop month
Alternative entries
35
contribution amount
for your SSN
(a) Alternative family size (b) Alternative monthly
(c) Alternative start month
(d) Alternative stop month
Alternative entries
36
contribution amount
for your spouse’s
SSN
8962
Form
(2018)

Download IRS Form 8962 2018 Premium Tax Credit (Ptc)

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