8962 Tax Form 2024 - Fill, Sign Online, Download & Print - No Signup

Form

8962

Department of the Treasury

Internal Revenue Service

Premium Tax Credit (PTC)

Attach to Form 1040, 1040-SR, or 1040-NR.

Go to

www.irs.gov/Form8962

for instructions and the latest information.

OMB No. 1545-0074

20

24

Attachment

Sequence No.

73

Name shown on your return

Your social security number

A.

You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception. See instructions. If you qualify, check the box

Part I

Annual and Monthly Contribution Amount

1

Tax family size. Enter your tax family size. See instructions .

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1

2a

Modified AGI. Enter your modified AGI. See instructions

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2a

b

Enter the total of your dependents’ modified AGI. See instructions

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2b

3

Household income. Add the amounts on lines 2a and 2b. See instructions .

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3

4

Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3. See instructions. Check the

appropriate box for the federal poverty table used.

a

Alaska

b

Hawaii

c

Other 48 states and DC

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5

Household income as a percentage of federal poverty line (see instructions)

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5

%

6

Reserved for future use

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7

Applicable figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions

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7

8 a

Annual contribution amount. Multiply line 3 by

line 7. Round to nearest whole dollar amount

8a

8b

Monthly contribution amount. Divide line 8a

by 12. Round to nearest whole dollar amount

8b

Part II

Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit

9

Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage? See instructions.

Yes.

Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage.

No.

Continue to line 10.

10

See the instructions to determine if you can use line 11 or must complete lines 12 through 23.

Yes.

Continue to line 11. Compute your annual PTC. Then skip lines 12–23

and continue to line 24.

No.

Continue to lines 12–23. Compute

your monthly PTC and continue to line 24.

Annual

Calculation

(a)

Annual

enrollment

premiums (Form(s)

1095-A, line 33A)

(b)

Annual

applicable

SLCSP premium

(Form(s) 1095-A,

line 33B)

(c)

Annual

contribution amount

(line 8a)

(d)

Annual maximum

premium assistance

(subtract (c) from (b); if

zero or less, enter -0-)

(e)

Annual PTC allowed

(smaller of (a) or (d))

(f)

Annual advance

payment of PTC (Form(s)

1095-A, line 33C)

11

Annual Totals

Monthly

Calculation

(a)

Monthly

enrollment

premiums (Form(s)

1095-A, lines 21–32,

column A)

(b)

Monthly

applicable

SLCSP premium

(Form(s) 1095-A, lines

21–32, column B)

(c)

Monthly

contribution amount

(amount from line 8b

or alternative marriage

monthly calculation)

(d)

Monthly maximum

premium assistance

(subtract (c) from (b); if

zero or less, enter -0-)

(e)

Monthly PTC allowed

(smaller of (a) or (d))

(f)

Monthly advance

payment of PTC (Form(s)

1095-A, lines 21–32,

column C)

12

January

13

February

14

March

15

April

16

May

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June

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July

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August

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September

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October

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November

23

December

24

Total PTC. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here .

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24

25

Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here

25

26

Net PTC. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and on Schedule 3

(Form 1040), line 9. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24, leave this line

blank and continue to line 27

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Part III

Repayment of Excess Advance Payment of the Premium Tax Credit

27

Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here

27

28

Repayment limitation (see instructions)

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Excess advance PTC repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2 (Form 1040), line 1a

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For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 37784Z

Form

8962

(2024)

Form 8962 (2024)

Page

2

Part IV

Allocation of Policy Amounts

Complete the following information for up to four policy amount allocations. See instructions for allocation details.

Allocation 1

30

(a)

Policy Number (Form 1095-A, line 2)

(b)

SSN of other taxpayer

(c)

Allocation start month

(d)

Allocation stop month

Allocation percentage

applied to monthly

amounts

(e)

Premium Percentage

(f)

SLCSP Percentage

(g)

Advance Payment of the PTC

Percentage

Allocation 2

31

(a)

Policy Number (Form 1095-A, line 2)

(b)

SSN of other taxpayer

(c)

Allocation start month

(d)

Allocation stop month

Allocation percentage

applied to monthly

amounts

(e)

Premium Percentage

(f)

SLCSP Percentage

(g)

Advance Payment of the PTC

Percentage

Allocation 3

32

(a)

Policy Number (Form 1095-A, line 2)

(b)

SSN of other taxpayer

(c)

Allocation start month

(d)

Allocation stop month

Allocation percentage

applied to monthly

amounts

(e)

Premium Percentage

(f)

SLCSP Percentage

(g)

Advance Payment of the PTC

Percentage

Allocation 4

33

(a)

Policy Number (Form 1095-A, line 2)

(b)

SSN of other taxpayer

(c)

Allocation start month

(d)

Allocation stop month

Allocation percentage

applied to monthly

amounts

(e)

Premium Percentage

(f)

SLCSP Percentage

(g)

Advance Payment of the PTC

Percentage

34

Have you completed all policy amount allocations?

Yes.

Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-

allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on

lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.

No.

See the instructions to report additional policy amount allocations.

Part V

Alternative Calculation for Year of Marriage

Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.

To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.

35

Alternative entries

for your SSN

(a)

Alternative family size

(b)

Alternative monthly

contribution amount

(c)

Alternative start month

(d)

Alternative stop month

36

Alternative entries

for your spouse’s

SSN

(a)

Alternative family size

(b)

Alternative monthly

contribution amount

(c)

Alternative start month

(d)

Alternative stop month

Form

8962

(2024)