Instructions For Form 8928 - Return Of Certain Excise Taxes Under Chapter 43 Of The Internal Revenue Code - 2016
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5Instructions for Form 8928
Department of the Treasury
Internal Revenue Service
(Rev. September 2016)
For use with Form 8928 (Rev. May 2016)
Return of Certain Excise Taxes Under Chapter 43
of the Internal Revenue Code
3. Any employer liable for the tax
“timely mailing as timely filing/paying”
Section references are to the Internal Revenue
Code unless otherwise noted.
under section 4980E for failure to make
rule for tax returns and payments.
comparable Archer MSA contributions
These private delivery services include
Future Developments
for all participating employees.
only the following.
For the latest information about Form
DHL Express (DHL): DHL Express
4. Any employer liable for the tax
8928 and its instructions, such as
9:00, DHL Express 10:30, DHL Express
under section 4980G for failure to make
legislation enacted after they were
12:00, DHL Express Worldwide, DHL
comparable HSA contributions for all
published, go to
Express Envelope, DHL Import Express
participating employees.
10:30, DHL Import Express 12:00, and
General Instructions
When To File
DHL Import Express Worldwide.
Federal Express (FedEx): FedEx First
For a failure under section 4980B or
Purpose of Form
Overnight, FedEx Priority Overnight,
section 4980D, if the failure is by an
FedEx Standard Overnight, FedEx
File Form 8928 to report the tax due on
employer or other person responsible
2Day, FedEx International Next Flight
the following failures by group health
for providing or administering benefits
Out, FedEx International Priority, FedEx
plans or employers.
under the plan (such as an insurer or
International First, and FedEx
A failure to provide a level of
third-party administrator), file Form 8928
International Economy.
coverage of the costs of pediatric
on or before the due date for filing the
United Parcel Service (UPS): UPS
vaccines (as defined in section 2612 of
person's federal income tax return.
Next Day Air Early AM, UPS Next Day
the Public Health Services Act) that is
If the failure under section 4980B or
Air, UPS Next Day Air Saver, UPS 2nd
not below the coverage provided as of
section 4980D is by a multiemployer or
Day Air, UPS 2nd Day Air A.M., UPS
May 1, 1993.
multiple employer plan, file Form 8928
Worldwide Express Plus, and UPS
A failure to satisfy continuation
on or before the last day of the seventh
Worldwide Express.
coverage requirements under section
month following the end of the plan
The private delivery service can tell
4980B.
year.
you how to get written proof of the
A failure to meet portability, access,
mailing date.
For a failure under section 4980E or
renewability, and market reform
section 4980G, file Form 8928 on or
requirements under sections 9801,
Interest and Penalties
before the 15th day of the 4th month
9802, 9803, 9811, 9812, 9813, and
following the calendar year in which the
9815.
Interest. Interest is charged on taxes
noncomparable contributions were
A failure to make comparable Archer
not paid by the due date even if an
made.
medical savings account (MSA)
extension of time to file is granted.
contributions under section 4980E.
Extension. File Form 7004, Application
Interest is also charged on penalties
A failure to make comparable health
for Automatic Extension of Time to File
imposed from the due date, including
savings account (HSA) contributions
extensions, to the date of payment for
Certain Business Income Tax,
under section 4980G.
Information, and Other Returns, to
failure to file, negligence, fraud, gross
request an automatic extension of time
valuation overstatements, and
Who Must File
substantial understatements of tax. The
to file Form 8928. You must file Form
Form 8928 must be filed by the
7004 on or before the regular due date
interest rate is determined under section
following.
of Form 8928. See the Instructions for
6621.
Form 7004 for more information. Form
1. Any employer, group health plan,
Penalty for late filing of return. If you
7004 does not extend the time to pay
plan administrator, or plan sponsor
do not file a return by the due date,
excise taxes due under Form 8928.
liable for the tax under section 4980B
including extensions, you may have to
for failure to provide the required level of
pay a penalty of 5% of the unpaid tax for
Where To File
pediatric vaccine coverage or to offer
each month or part of a month the return
continuation coverage to a qualified
is late, up to a maximum of 25% of the
Send Form 8928 to the
beneficiary.
unpaid tax. The minimum penalty for a
following address.
2. Any employer or group health
return that is more than 60 days late is
plan liable for the tax under section
Department of the Treasury
the smaller of the tax due or $100. The
4980D for failure to meet portability,
Internal Revenue Service
penalty will not be imposed if you can
access, renewability, and market reform
show that the failure to file on time was
Cincinnati, OH 45999-0009
requirements for group health plans
due to reasonable cause. If you file late,
under sections 9801, 9802, 9803, 9811,
you must attach a statement to Form
9812, 9813, and 9815.
8928 explaining the reasonable cause.
Private delivery services. You can
use certain private delivery services
designated by the IRS to meet the
Sep 01, 2016
Cat. No. 52470C
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