Instructions For Form 1095-A Draft - Health Insurance Marketplace Statement

Instructions For Form 1095-A Draft - Health Insurance Marketplace Statement - 2015 Page 4

Correction to Information Reported

Revenue law. Generally, tax returns and return

information are confidential, as required by IRC section

Report corrected information on the Form 1095-A to the

6103.

IRS and to the recipient as soon as possible after

discovering that information reported is incorrect. Check

The time needed to complete and file this form will vary

the corrected box on the top of the form.

depending on individual circumstances. The estimated

average time is:

Privacy Act and Paperwork Reduction Act Notice.

We ask for the information on this form to carry out the

DRAFT AS OF

Preparing the form

.3 min.

. . . . . . . . . . . .

Internal Revenue laws of the United States. You are

required by the Internal Revenue Code to give us the

information. We need it to ensure that taxpayers are

If you have comments concerning the accuracy of

complying with these laws and to allow us to figure and

these time estimates or suggestions for making this form

collect the right amount of tax.

simpler, we would be happy to hear from you. You can

August 4, 2015

You aren't required to provide the information

write to the Internal Revenue Service; Tax Forms and

requested on a form that is subject to the Paperwork

Publications Division; SE:W:CAR:MP:T, 1111 Constitution

Reduction Act unless the form displays a valid OMB

Ave. NW, IR-6526, Washington, DC 20224. Don't send

control number. Books or records relating to a form or its

the form to this office. Instead, see Where To File, earlier.

instructions must be retained as long as their contents

may become material in the administration of any Internal

-3-

Instructions for Form 1095-A 2015

Instructions For Form 1095-A Draft - Health Insurance Marketplace Statement - 2015 Page 4