IRS Form 1099-H 2018 Health Coverage Tax Credit (Hctc) Advance Payments

IRS Form 1099-H or the "Health Coverage Tax Credit (hctc) Advance Payments" is a form issued by the U.S. Department of the Treasury - Internal Revenue Service.

A PDF of the latest IRS Form 1099-H 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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7171
VOID
CORRECTED
ISSUER'S/PROVIDER'S name, street address, city or town, state or province,
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
country, ZIP or foreign postal code, and telephone no.
$
2018
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
2018 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
7171
VOID
CORRECTED
ISSUER'S/PROVIDER'S name, street address, city or town, state or province,
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
country, ZIP or foreign postal code, and telephone no.
$
2018
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
2018 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 province,
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
country, ZIP or foreign postal code, and telephone no.
$
2018
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 province,
1 Amount of HCTC advance
OMB No. 1545-1813
payments
Health Coverage
country, ZIP or foreign postal code, and telephone no.
$
2018
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
$
$
2018 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:
April 1, 2019. To file electronically, you must have
• the 2018 General Instructions for Certain Information
software that generates a file according to the
Returns, and
specifications in Pub. 1220.
• the 2018 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, 2019.
disability with access to TTY/TDD equipment can call
304-579-4827 (not toll free).

Download IRS Form 1099-H 2018 Health Coverage Tax Credit (Hctc) Advance Payments

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