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Federal Free Printable Form 1099-H (Rev. January 2022) for 2022 Federal Health Coverage Tax Credit (HCTC) Advance Payments

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Health Coverage Tax Credit (HCTC) Advance Payments
Form 1099-H (Rev. January 2022)

9090 VOID CORRECTED ISSUER'S/PROVIDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Amount of HCTC advance payments $ OMB No. 1545-1813 1099-H 2 No. of mos. HCTC payments received Form (Rev. January 2022) For calendar year 3 Jan. 9 July $ $ 4 Feb. 10 Aug. 20 ISSUER'S/PROVIDER'S TIN RECIPIENT'S TIN RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Form 1099-H (Rev. 1-2022) Cat. No. 34912D $ $ 5 Mar. 11 Sept. $ $ 6 Apr. 12 Oct. $ $ 7 May 13 Nov. $ $ 8 June 14 Dec. $ $ www.irs.gov/Form1099H Health Coverage Tax Credit (HCTC) Advance Payments Copy A For Internal Revenue Service Center For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. 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, country, ZIP or foreign postal code, and telephone no. 1 Amount of HCTC advance payments $ 2 No. of mos. of HCTC advance payments and reimbursement credits paid to you OMB No. 1545-1813 ISSUER'S/PROVIDER'S TIN 3 Jan. 9 July 1099-H Form (Rev. January 2022) For calendar year 20 RECIPIENT'S TIN RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Form 1099-H (Rev. 1-2022) (keep for your records) $ $ 4 Feb. 10 Aug. $ $ 5 Mar. 11 Sept. $ $ 6 Apr. 12 Oct. $ $ 7 May 13 Nov. $ $ 8 June 14 Dec. $ $ www.irs.gov/Form1099H Health Coverage Tax Credit (HCTC) Advance Payments Copy B For Recipient This is important tax information and is being furnished to the IRS. Department of the Treasury - Internal Revenue Service Instructions for Recipient This statement is provided to you because you received Health Coverage Tax Credit (HCTC) advance payments of your health coverage insurance premiums. These advance payments were forwarded directly to your health insurance provider. You are qualified to receive advance payments if you were an eligible trade adjustment assistance (TAA) recipient, an Alternative TAA (ATAA) recipient, a Reemployment TAA (RTAA) recipient, or a Pension Benefit Guaranty Corporation (PBGC) pension payee. See Form 8885, Health Coverage Tax Credit, and its instructions for more details on qualified recipients and how to figure any credit that you may be able to take on your Form 1040, 1040-SR, 1040-NR, 1040-SS, or 1040-PR. Recipient’s taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (social security number (SSN), individual taxpayer identification number (ITIN), or adoption taxpayer identification number (ATIN)). However, the issuer has reported your complete TIN to the IRS. Box 1. Shows the total amount of HCTC advance payments of qualified health insurance costs that were made on your behalf. Box 2. Shows the total number of months you received HCTC payments. Boxes 3 through 14. Shows the amount of HCTC advance payments paid for you for each month. The total of the amounts shown in these boxes equals the amount shown in box 1. Future developments. For the latest information about developments related to Form 1099-H and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099H. Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online federal tax preparation, e-filing, and direct deposit or payment options. VOID CORRECTED ISSUER'S/PROVIDER'S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Amount of HCTC advance payments $ OMB No. 1545-1813 1099-H 2 No. of mos. HCTC payments received Form (Rev. January 2022) For calendar year 3 Jan. 9 July 20 ISSUER'S/PROVIDER'S TIN RECIPIENT'S TIN RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Form 1099-H (Rev. 1-2022) $ $ 4 Feb. 10 Aug. $ $ 5 Mar. 11 Sept. $ $ 6 Apr. 12 Oct. $ $ 7 May 13 Nov. $ $ 8 June 14 Dec. $ $ www.irs.gov/Form1099H Health Coverage Tax Credit (HCTC) Advance Payments Copy C For Issuer/Provider For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. Department of the Treasury - Internal Revenue Service Instructions for Issuer/Provider To complete Form 1099-H, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Form 1099-H. To order these instructions and additional forms, go to www.irs.gov/EmployerForms. Filing and furnishing. For filing and furnishing instructions, including due dates, and requesting filing or furnishing extensions, see the current General Instructions for Certain Information Returns. Need help? If you have questions about reporting on Form 1099-H, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free).
Extracted from PDF file 2022-federal-form-1099-h.pdf, last modified December 2021

More about the Federal Form 1099-H Other Tax Credit TY 2022

We last updated the Health Coverage Tax Credit (HCTC) Advance Payments in April 2022, so this is the latest version of Form 1099-H, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form 1099-H directly from TaxFormFinder. You can print other Federal tax forms here.


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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 1099-H from the Internal Revenue Service in April 2022.

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Form 1099-H is a Federal Other form. States often have dozens of even hundreds of various tax credits, which, unlike deductions, provide a dollar-for-dollar reduction of tax liability. Some common tax credits apply to many taxpayers, while others only apply to extremely specific situations. In most cases, you will have to provide evidence to show that you are eligible for the tax credit, and calculate the amount of the credit to which you are entitled.

Historical Past-Year Versions of Federal Form 1099-H

We have a total of ten past-year versions of Form 1099-H in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2022 Form 1099-H

Form 1099-H (Rev. January 2022)

2020 Form 1099-H

Form 1099-H (Rev. 12-2020)

2019 Form 1099-H

Form 1099-H (Rev. 12-2020)

2018 Form 1099-H

2018 Form 1099-H

2017 Form 1099-H

2017 Form 1099-H

2016 Form 1099-H

2016 Form 1099-H

Health Coverage Tax Credit (HCTC) Advance Payments 2015 Form 1099-H

2016 Form 1099-H

Health Coverage Tax Credit (HCTC) Advance Payments 2013 Form 1099-H

2013 Form 1099-H

Health Coverage Tax Credit (HCTC) Advance Payments 2012 Form 1099-H

2012 Form 1099-H

Health Coverage Tax Credit (HCTC) Advance Payments 2011 Form 1099-H

2012 Form 1099-H


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