Contents -

Form 1099-H
NOTE

ANY INSTRUCTIONS CONTAINED HEREIN ARE ADVISORY ONLY.

REFER TO IRS INSTRUCTIONS FOR OFFICIAL INFORMATION.



Form 1099-H - Health Coverage Tax Credit (HCTC) Advance Payments

File Form 1099-H if you received in the course of your trade or business any advance payments during the calendar year of qualified health insurance payments for the benefit of eligible trade adjustment assistance (TAA), alternative TAA, or Pension Benefit Guaranty Corporation (PBGC) recipients and their qualifying family members.

Account number (Required)
Enter any number assigned by the payer to the payee that can be used by the IRS to distinguish between information returns.  This number must be unique for each information return.  The account number is critical in the correction process, especially when more than one information return is filed for a payee.  MAG-FILER will automatically assign an account number if the field is blank.

TIN # (Required)
Enter the payee's valid 9-digit Taxpayer Identification Number (SSN or EIN, as appropriate).  Leave this field blank if the TIN# is unknown.   Any form filed containing an invalid identification number in this entry may be returned for correction.

SSN  (else EIN) (Required)
Check this box if the payee TIN # is a Social Security Number (SSN) of an individual.  Leave this box blank if the payee TIN # is an Employer Identification Number (EIN) of a business or an organization.

NOTE: Imbedded blanks, extraneous words, titles, and special characters ( i.e., Mr., Mrs., Dr., period [.], apostrophe [ ' ] should be removed from Payee Name Lines.  An ampersand (&) and a dash (- ) are the only acceptable special characters.  A comma ( , ) between last name and first name that is placed by MAG-FILER is also acceptable.

Name (Required)
Enter the name of the recipient belonging to the Taxpayer Identification Number (TIN).  If the TIN, is an SSN, enter as last name suffix, first, middle initial, e.g., Doe Jr., John A.).  If the TIN is an EIN, the name is entered as is.  Use the Second Name Field if additional space is required.

Second Name Field
If the payee name requires more space than is available in the name field, ENTER ONLY THE REMAINING PORTION OF THE NAME IN THIS ENTRY.  If there are multiple payees, this field may be used for those payees' names.  DO NOT USE THIS FIELD FOR ADDRESS INFORMATION. 

Address (Required)
Enter the payee's mailing address.  The address MUST be present.  This entry must not contain any data other than the payee's mailing address.

City (Required)
Enter the payee's city.   Do not enter state and zip code information in this entry.

State (Required)
Enter the abbreviation for the payee's state or foreign country.  You must use valid U.S. Postal Service state abbreviations for U.S. addresses.

Zip (Required)
Enter the payee's valid 9-digit zip code assigned by the U.S. Postal Service.

Amt of  HCTC Advance Payments (required)
Enter the total amount of advance payments of health insurance premiums received on behalf of the recipient from January  1 through  - December 31 of the current tax year.  The amount received cannot exceed 65% of the total health insurance premium for the individual.

No. of mos. HCTC advance payments received 
Enter the number of months for which payments were received on behalf of the recipient.  This number cannot be more than 12.  Enter 1 - 12.

Jan - Dec
Enter the amount of advance payment received for each month in the applicable field.  You may receive these payments prior to the month for which they are paid.  Be sure to enter the amounts in the correct field.

Special
This area may be used to record information for state or local government reporting or for the filer's own purposes.  This information will be sent to the IRS file and does not print to the form.

Select Print
Check this box to select specific payees for printing.

Corrected Return
Check this box if this entry is a corrected return.  This is only used IF YOU HAVE ALREADY SUBMITTED MAGNETIC MEDIA FILING and wish to print or file corrected returns.  NOTE: The same account number reported on the original must also be on the corrected record.