Affordable Care Act Questionnaire Form (Page 2 of 2) in pdf

Affordable Care Act Questionnaire Form Page 2

Notes for tax preparer

1. If you are confident that the taxpayer(s) and dependents of the taxpayer(s)

have minimum essential health coverage for the entire year, you can check

the “Full-year coverage” box on line 61 of Form 1040, line 11 on Form

1040EZ, or line 38 on Form 1040A and you do not need to calculate a

shared responsibility payment. Document any evidence that the taxpayer(s)

and dependents have insurance. (Note: if no one claims a child as a

dependent, the taxpayer who could have claimed the child as a dependent

must include the child in computing a shared responsibility payment.)

2. If a family member did not have health insurance for any month in 2014,

you must file Form 8965 to compute the shared responsibility payment (if

any) the taxpayer(s) must include on line 61 of Form 1040, line 11 of Form

1040EZ, or line 38 of Form 1040A.

3. If the taxpayer(s) have insurance from the Government Marketplace,

complete Form 8962 to calculate the final Premium Tax Credit (if any) and

to reconcile the Advance Premium Tax Credit (if any) with the final

Premium Tax Credit.

Affordable Care Act Questionnaire Form Page 2