Federal Declaration and Signature for Electronic Filing of Forms 8947 and 8963
Extracted from PDF file 2019-federal-form-8453-r.pdf, last modified January 2020
Declaration and Signature for Electronic Filing of Forms 8947 and 89638453-R Form (Rev. January 2020) Department of the Treasury Internal Revenue Service Electronic Filing Declaration for Form 8963 ▶ Go OMB No. 1545-2253 to www.irs.gov/Form8453R for the latest information. For calendar year 20 Employer identification number Name of organization Declaration of Officer Under penalties of perjury, I declare that I have examined the electronic report, including accompanying statements, and, to the best of my knowledge and belief, it is true, correct, and complete. If I am signing as the designated entity, I also declare that the above named entity is the agent of an affiliated group or other designated entity (as per the instructions). I understand that the designated entity will receive IRS communications relating to the fee imposed by ACA section 9010 and is to pay this fee to the IRS on behalf of the controlled group. Each person that is a controlled group member at the end of the day on December 31, 2019, is jointly and severally liable for this fee. I further declare that each controlled group member identified on the electronic report consents to the choice of the designated entity indicated on that report. I further certify that I am an officer of the single-person covered entity or the designated entity, and that I am duly authorized to sign this report on behalf of that covered entity. Each person who is a controlled group member at the end of the day on December 31, 2019, and would qualify as a covered entity in 2020 if it were a single-person covered entity is jointly and severally liable for any applicable penalty under ACA section 9010. (Where the designated entity is selected by the IRS, each entity in this report is deemed to consent to the choice of designated entity.) ▲ Sign Here Signature of officer Date Print name of signing official Title Daytime telephone number Fax number Future Developments For the latest information about developments related to Form 8453-R and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form8453R. Purpose of Form Use Form 8453-R to authenticate the electronic filing of Form 8963, Report of Health Insurance Provider Information. Who Must File If you file Form 8963 electronically in 2020, you must upload Form 8453-R with your report. When To File Form 8453-R must be filed with your electronically filed Form 8963. How To File Create a PDF file of the completed Form 8453-R and upload it with Form 8963. Declaration of Officer The declaration of officer must be signed and dated by: • The president, vice president, treasurer, assistant treasurer, chief accounting officer; or • Any other officer of the organization, such as an officer of the single-person covered entity or the designated entity, authorized to sign the organization’s report. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of fees. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The rules governing the confidentiality of this form are covered in Internal Revenue Code section 6103. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is: An electronically transmitted report will not be considered complete (and therefore not considered filed) unless Form 8453-R is signed by an officer of the organization, scanned into a PDF file, and transmitted with the report. Recordkeeping . The officer’s signature allows the IRS to disclose to the transmitter: Comments. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from www.irs.gov/FormComments. Or you can write to the Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Don’t send the form to this office. • An acknowledgement that the IRS has accepted the organization’s electronically filed report, and • The reason(s) for a delay in processing the report. For Paperwork Reduction Act Notice, see instructions. . . . . . . 1 hr., 12 min. Learning about the law or the form . . . . . . . 12 min. Preparing and sending the form . . . . . . . 13 min. Cat. No. 60914Z . . . . . . Form 8453-R (Rev. 1-2020)
Form 8453-R (Rev. January 2020)
More about the Federal Form 8453-R Other
Form no longer used.
We last updated the Declaration and Signature for Electronic Filing of Forms 8947 and 8963 in February 2020, and the latest form we have available is for tax year 2019. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Federal Internal Revenue Service. You can print other Federal tax forms here.
Other Federal Other Forms:
|Form Code||Form Name|
|Form W-4V||Voluntary Withholding Request|
|Form 8962||Premium Tax Credit|
|Form 14039||Identity Theft Affidavit|
|Form 8949||Sales and other Dispositions of Capital Assets|
|Form 8965||Health Coverage Exemptions|
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 8453-R from the Internal Revenue Service in February 2020.
Historical Past-Year Versions of Federal Form 8453-R
We have a total of six past-year versions of Form 8453-R in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
Form 8453-R (Rev. January 2020)
Form 8453-R (Rev. January 2018)
Form 8453-R (Rev. December 2016)
Form 8453-R (Rev. December 2016)
Form 8453-R (Rev. February 2016)
Form 8453-R (Rev. January 2014)
While we do our best to keep our list of Federal Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.