Federal Free Printable 2016 Form 1099-H for 2017 Federal Health Coverage Tax Credit (HCTC) Advance Payments

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Health Coverage Tax Credit (HCTC) Advance Payments
2016 Form 1099-H

Attention: Copy A of this form is provided for informational purposes only. Copy A appears in red, similar to the official IRS form. The official printed version of Copy A of this IRS form is scannable, but the online version of it, printed from this website, is not. Do not print and file copy A downloaded from this website; a penalty may be imposed for filing with the IRS information return forms that can’t be scanned. See part O in the current General Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more information about penalties. Please note that Copy B and other copies of this form, which appear in black, may be downloaded and printed and used to satisfy the requirement to provide the information to the recipient. To order official IRS information returns, which include a scannable Copy A for filing with the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on Employer and Information Returns, and we’ll mail you the forms you request and their instructions, as well as any publications you may order. Information returns may also be filed electronically using the IRS Filing Information Returns Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act Information Returns (AIR) program (visit www.IRS.gov/AIR). See IRS Publications 1141, 1167, and 1179 for more information about printing these tax forms. 7171 VOID CORRECTED ISSUER'S/PROVIDER'S name, street address, city or town, state or province, 1 Amount of HCTC advance payments country, ZIP or foreign postal code, and telephone no. $ 2 No. of mos. HCTC payments received OMB No. 1545-1813 2016 Form 1099-H ISSUER'S/PROVIDER'S federal identification number RECIPIENT'S identification number RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code 3 Jan. 9 July $ $ 4 Feb. 10 Aug. $ $ 5 Mar. 11 Sept. $ $ 6 Apr. 12 Oct. $ $ 7 May 13 Nov. $ $ 8 June 14 Dec. $ $ Health Coverage Tax Credit (HCTC) Advance Payments Copy A For Internal Revenue Service Center For Privacy Act and Paperwork Reduction Act Notice, see the 2016 General Instructions for Certain Information Returns. 1099-H 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 Form CORRECTED (if checked) ISSUER'S/PROVIDER'S name, street address, city or town, state or province, 1 Amount of HCTC advance payments country, ZIP or foreign postal code, and telephone no. $ 2 No. of mos. of HCTC advance payments and reimbursement credits paid to you OMB No. 1545-1813 2016 Form 1099-H ISSUER'S/PROVIDER'S federal identification number RECIPIENT'S identification number RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Form 1099-H (keep for your records) 3 Jan. 9 July $ $ 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 Internal Revenue Service. 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), Alternative TAA, Reemployment TAA 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, 1040NR, 1040-SS, or 1040-PR. 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. VOID CORRECTED ISSUER'S/PROVIDER'S name, street address, city or town, state or province, 1 Amount of HCTC advance payments country, ZIP or foreign postal code, and telephone no. $ 2 No. of mos. HCTC payments received OMB No. 1545-1813 2016 Form 1099-H ISSUER'S/PROVIDER'S federal identification number RECIPIENT'S identification number RECIPIENT'S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Form 1099-H 3 Jan. 9 July $ $ 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 2016 General Instructions for Certain Information Returns. Department of the Treasury - Internal Revenue Service Instructions for Issuer/Provider To complete Form 1099-H, use: • the 2016 General Instructions for Certain Information Returns, and • the 2016 Instructions for Form 1099-H. To order these instructions and additional forms, go to www.irs.gov/form1099h. Caution: Because paper forms are scanned during processing, you cannot file Forms 1096, 1097, 1098, 1099, 3921, 3922, or 5498 that you print from the IRS website. Due dates. Furnish Copy B of this form to the recipient by January 31, 2017. File Copy A of this form with the IRS by February 28, 2017. If you file electronically, the due date is March 31, 2017. To file electronically, you must have software that generates a file according to the specifications in Pub. 1220. The IRS does not provide a fill-in form option. Need help? If you have questions about reporting on Form 1099-H, call the information reporting customer service site toll free at 1-866-455-7438 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 2016-federal-form-1099-h.pdf, last modified December 2015

More about the Federal Form 1099-H Other Tax Credit TY 2016

We last updated the Health Coverage Tax Credit (HCTC) Advance Payments in May 2017, so this is the latest version of Form 1099-H, fully updated for tax year 2016. 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 May 2017.

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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 five 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:


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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