Irs Form 8965 PDF Details

In the landscape of United States tax obligations, navigating the requirements for health insurance coverage can be complex. The IRS Form 8965, titled Health Coverage Exemptions, plays a crucial role in this context, facilitating individuals' ability to report periods of uninsurance without facing penalties under the Affordable Care Act (ACA). This form is pivotal for those who either qualify for exemptions from the ACA's coverage mandate due to various recognized reasons, including financial hardship or membership in certain groups, or those whose household income falls below the filing threshold. By attaching it to Form 1040, taxpayers communicate with the Internal Revenue Service (IRS) about their insurance status, whether they've received an exemption directly from the Health Insurance Marketplace or are claiming it on their return. The form is divided into sections designed to detail Marketplace-granted exemptions, as well as those claimed directly on the return, covering every individual within a tax household and specifying the type and duration of each exemption claimed. As healthcare laws and tax regulations evolve, staying informed about forms like Form 8965 and their proper application is indispensable for compliance and avoiding unnecessary penalties.

QuestionAnswer
Form NameIrs Form 8965
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform 8965 instructions, health care exemption form 8965, irs 8965, 8695 form

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Form 8965

Health Coverage Exemptions

OMB No. 1545-0074

 

2018

Department of the Treasury

Attach to Form 1040.

Go to www.irs.gov/Form8965 for instructions and the latest information.

Attachment

Internal Revenue Service

Sequence No. 75

Name as shown on return

 

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.

 

 

Marketplace-Granted Coverage Exemptions for Individuals. If you and/or a member of your tax household

Part I

have an exemption granted by the Marketplace, complete Part I.

 

 

 

 

 

 

(a)

(b)

(c)

 

 

Name of Individual

SSN

Exemption Certificate Number

 

 

 

 

 

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

4

 

 

 

 

5

 

 

 

 

6

 

 

 

 

Part II

Coverage Exemptions Claimed on Your Return

for Your Household

 

7If you are claiming a coverage exemption because your household income or gross income is below the filing threshold,

 

check here

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Coverage Exemptions Claimed on Your Return for Individuals. If you and/or a member of your tax

 

Part III

 

household are claiming an exemption on your return, complete Part III.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a)

(b)

(c)

(d)

(e)

(f)

 

(g)

(h)

(i)

(j)

(k)

(l)

(m)

(n)

(o)

(p)

 

 

Exemption

Full

 

 

 

Name of Individual

SSN

Jan

Feb

 

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

 

 

Type

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

How to Edit Irs Form 8965 Online for Free

It really is very easy to fill out the form 8965. Our editor was intended to be help you fill in any document promptly. These are the steps to follow:

Step 1: Select the button "Get Form Here".

Step 2: You're now free to alter form 8965. You have plenty of options with our multifunctional toolbar - you can include, delete, or change the content material, highlight its selected sections, as well as perform various other commands.

All of the following areas are what you are going to create to receive the prepared PDF form.

8965 form 2020 pdf fields to complete

Fill out the If you are claiming a coverage, Part II, Part III, a Name of Individual, b SSN, c Exemption Type, d Full Year, e Jan, f Feb, g Mar, h Apr, i May, j June, k July, and l Aug space using the particulars requested by the software.

part 2 to filling out 8965 form 2020 pdf

Step 3: Select the "Done" button. Finally, you may export the PDF file - save it to your electronic device or send it through email.

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