Form 1099-H - Health Coverage Tax Credit (Hctc) Advance Payments

Form 1099-H - Health Coverage Tax Credit (Hctc) Advance Payments - 2012 Page 4

Instructions for Recipient

Recipient's identification number. For your protection,

instructions for more details on qualified recipients and

this form may show only the last four digits of your social

how to figure any credit that you may be able to take on

security number (SSN), individual taxpayer identification

your Form 1040, 1040NR, 1040-SS, or 1040-PR.

number (ITIN), or adoption taxpayer identification

Box 1. Shows the total amount of HCTC advance

number (ATIN). However, the issuer has reported your

payments of qualified health insurance costs that were

complete identification number to the IRS and, where

made on your behalf. Do not report this amount on Form

applicable, to state and/or local governments.

8885. This amount is in lieu of any credit you will be able

This statement is provided to you because you

to take on Form 1040, 1040NR, 1040-SS, or 1040-PR,

received HCTC advance payments of your health

because it was paid for you in advance.

coverage insurance premiums. These advance

Box 2. Shows the total number of months you received

payments were forwarded directly to your health

HCTC payments.

insurance provider. You qualify to receive advance

Boxes 3 through 14. Shows the amount of HCTC

payments if you were an eligible trade adjustment

advance payments paid for you for each month. The

assistance (TAA), Reemployment TAA, or a Pension

total of the amounts shown in these boxes equals the

Benefit Guaranty Corporation (PBGC) pension recipient.

amount shown in box 1.

See Form 8885, Health Coverage Tax Credit, and its

Form 1099-H - Health Coverage Tax Credit (Hctc) Advance Payments - 2012 Page 4