Federal Health Coverage Exemptions
Extracted from PDF file 2019-federal-form-8965.pdf, last modified December 2018
Health Coverage ExemptionsForm 8965 OMB No. 1545-0074 Health Coverage Exemptions Department of the Treasury Internal Revenue Service ▶ 2018 ▶ Attach to Form 1040. Go to www.irs.gov/Form8965 for instructions and the latest information. Name as shown on return Attachment Sequence No. 75 Your social security number Complete this form if you have a Marketplace-granted coverage exemption or you are claiming a coverage exemption on your return. Part I Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household have an exemption granted by the Marketplace, complete Part I. (a) Name of Individual (b) SSN (c) Exemption Certificate Number 1 2 3 4 5 6 Part II 7 Coverage Exemptions Claimed on Your Return for Your Household If you are claiming a coverage exemption because your household income or gross income is below the filing threshold, ▶ check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part III Coverage Exemptions Claimed on Your Return for Individuals. If you and/or a member of your tax household are claiming an exemption on your return, complete Part III. (a) Name of Individual (b) SSN (c) (d) Exemption Full Type Year (e) Jan (f) Feb (g) Mar (h) Apr (i) (j) (k) May June July (l) Aug (m) Sept (n) Oct (o) Nov (p) Dec 8 9 10 11 12 13 For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37787G Form 8965 (2018)
2018 Form 8965
More about the Federal Form 8965 Other TY 2019
Only available up to 2018.
We last updated the Health Coverage Exemptions in March 2020, so this is the latest version of Form 8965, fully updated for tax year 2019. You can download or print current or past-year PDFs of Form 8965 directly from TaxFormFinder. You can print other Federal tax forms here.
Related Federal Other Forms:
|Form Code||Form Name|
|8965||Health Coverage Exemptions|
|Inst 8965||Instructions for 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 8965 from the Internal Revenue Service in March 2020.
Historical Past-Year Versions of Federal Form 8965
We have a total of six past-year versions of Form 8965 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
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