Instructions For Form 1095-A - Health Insurance Marketplace Statement - 2015 Page 3
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3Void Statements
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its
If a Form 1095-A was sent for a policy that shouldn't be
instructions must be retained as long as their contents
reported on a Form 1095-A, such as a separate dental
may become material in the administration of any Internal
plan or a catastrophic health plan, send a duplicate of that
Revenue law. Generally, tax returns and return
Form 1095-A and check the void box at the top of the
information are confidential, as required by IRC section
form. Provide this information to the IRS and the
6103.
statement recipient as soon as possible after discovering
that the statement was sent in error.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
Correction to Information Reported
average time is:
Report corrected information on the Form 1095-A to the
IRS and to the recipient as soon as possible after
Preparing the form
.3 min.
. . . . . . . . . . . .
discovering that information reported is incorrect. Check
the corrected box on the top of the form.
If you have comments concerning the accuracy of
Privacy Act and Paperwork Reduction Act Notice.
these time estimates or suggestions for making this form
We ask for the information on this form to carry out the
simpler, we would be happy to hear from you. You can
Internal Revenue laws of the United States. You are
write to the Internal Revenue Service; Tax Forms and
required by the Internal Revenue Code to give us the
Publications Division; SE:W:CAR:MP:T, 1111 Constitution
information. We need it to ensure that taxpayers are
Ave. NW, IR-6526, Washington, DC 20224. Don't send
complying with these laws and to allow us to figure and
the form to this office. Instead, see Where To File, earlier.
collect the right amount of tax.
You aren't required to provide the information
requested on a form that is subject to the Paperwork
-3-
Instructions for Form 1095-A 2015
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