Form 8962, Premium Tax Credit (PTC) Instructions
This form contains 141 fields organized into 17 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Information | ||
| (þÿ�f�1�_�4�8�[�0�]) | Text |
Enter any additional information or notes related to the form.
|
| Advance Payments | ||
| (þÿ�f�1�_�4�3�[�0�]) | Text |
Enter the total advance payments of the premium tax credit.
|
| (þÿ�f�1�_�4�5�[�0�]) | Text |
Enter the total amount of advance payments reconciled.
|
| Alternative Calculation | ||
| (þÿ�f�1�_�4�7�[�0�]) | Text |
Enter the alternative calculation for the year of marriage.
|
| Alternative family size | Text |
Enter the alternative family size for the year of marriage calculation.
|
| (b) Alternative monthly contribution amount | Text |
Enter the alternative monthly contribution amount for the year of marriage calculation.
|
| Alternative start month | Text |
Enter the alternative start month for the year of marriage calculation.
|
| Alternative family size | Text |
Enter the alternative family size for the year of marriage calculation.
|
| (b) Alternative monthly contribution amount | Text |
Enter the alternative monthly contribution amount for the year of marriage calculation.
|
| Alternative start month | Text |
Enter the alternative start month for the year of marriage calculation.
|
| Alternative stop month | Text |
Enter the alternative stop month for the year of marriage calculation.
|
| Annual Contribution Amount | ||
| (þÿ�f�1�_�2�9�[�0�]) | Text |
Enter the annual contribution amount for the Premium Tax Credit.
|
| Calculation | ||
| 8a Annual contribution amount. Multiply line 3 by line 7. Round to nearest whole dollar amount | Text |
Enter the annual contribution amount by multiplying line 3 by line 7. Round to the nearest whole dollar amount.
|
| Monthly contribution amount. Divide line 8a by 12. Round to nearest whole dollar amount | Text |
Enter the monthly contribution amount by dividing line 8a by 12. Round to the nearest whole dollar amount.
|
| Family Information | ||
| Tax family size. Enter your tax family size. See instructions | Text |
Enter the size of your tax family. Refer to the instructions for more details.
|
| General | ||
| (þÿ�c�1�_�1�[�0�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�f�1�_�4�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�6�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�c�1�_�2�[�0�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�c�1�_�2�[�1�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�c�1�_�2�[�2�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�f�1�_�7�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�c�1�_�4�[�0�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�c�1�_�4�[�1�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�c�1�_�5�[�0�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�c�1�_�5�[�1�]) | CheckBox |
Check this box if applicable.
|
| (þÿ�f�1�_�1�3�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�4�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�5�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�6�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�7�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�8�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�1�9�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�0�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�1�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�2�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�3�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�4�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�5�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�6�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�7�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�2�8�[�0�]) | Text |
Enter the required information as per the form instructions.
|
| (þÿ�f�1�_�9�3�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�f�1�_�9�4�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�f�1�_�9�5�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�f�1�_�9�6�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| (e) Premium Percentage | Text |
Enter the premium percentage for the policy.
|
| (f) SLCSP Percentage | Text |
Enter the Second Lowest Cost Silver Plan (SLCSP) percentage.
|
| (g) Advance Payment of the PTC Percentage | Text |
Enter the percentage of the advance payment of the Premium Tax Credit (PTC).
|
| (c) Allocation start month | Text |
Enter the month when the allocation of the policy starts.
|
| (þÿ�f�2�_�1�4�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�c�2�_�1�[�0�]) | CheckBox |
This checkbox is used to indicate a specific option related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�c�2�_�1�[�1�]) | CheckBox |
This checkbox is used to indicate a specific option related to the form. The exact purpose is unclear due to the encoding issue.
|
| (þÿ�f�2�_�3�2�[�0�]) | Text |
This field is used to input a specific value related to the form. The exact purpose is unclear due to the encoding issue.
|
| General Information | ||
| (þÿ�f�1�_�6�1�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�2�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�3�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�4�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�5�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�6�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�7�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�8�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�6�9�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�0�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�1�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�2�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�3�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�4�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�5�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�6�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�7�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�8�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�7�9�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�0�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�1�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�2�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�3�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�4�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�5�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�6�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�7�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�8�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�8�9�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�9�0�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| (þÿ�f�1�_�9�2�[�0�]) | Text |
This field is part of the form and requires specific information related to the Premium Tax Credit calculation.
|
| Income Information | ||
| Enter the total of your dependents' modified AGI. See instructions | Text |
Enter the total modified adjusted gross income (AGI) of your dependents. Refer to the instructions for more details.
|
| Household income as a percentage of federal poverty line (see instructions) | Text |
Enter your household income as a percentage of the federal poverty line. Refer to the instructions for more details.
|
| Applicable figure. Using your line 5 percentage, locate your | Text |
Enter the applicable figure based on your line 5 percentage. Refer to the instructions for more details.
|
| Monthly Contribution Amount | ||
| (þÿ�f�1�_�3�0�[�0�]) | Text |
Enter the monthly contribution amount for January.
|
| (þÿ�f�1�_�3�1�[�0�]) | Text |
Enter the monthly contribution amount for February.
|
| (þÿ�f�1�_�3�2�[�0�]) | Text |
Enter the monthly contribution amount for March.
|
| (þÿ�f�1�_�3�3�[�0�]) | Text |
Enter the monthly contribution amount for April.
|
| (þÿ�f�1�_�3�4�[�0�]) | Text |
Enter the monthly contribution amount for May.
|
| (þÿ�f�1�_�3�5�[�0�]) | Text |
Enter the monthly contribution amount for June.
|
| (þÿ�f�1�_�3�6�[�0�]) | Text |
Enter the monthly contribution amount for July.
|
| (þÿ�f�1�_�3�7�[�0�]) | Text |
Enter the monthly contribution amount for August.
|
| (þÿ�f�1�_�3�8�[�0�]) | Text |
Enter the monthly contribution amount for September.
|
| (þÿ�f�1�_�3�9�[�0�]) | Text |
Enter the monthly contribution amount for October.
|
| (þÿ�f�1�_�4�0�[�0�]) | Text |
Enter the monthly contribution amount for November.
|
| (þÿ�f�1�_�4�1�[�0�]) | Text |
Enter the monthly contribution amount for December.
|
| Personal Information | ||
| Name shown on your return | Text |
Enter the name that is shown on your tax return.
|
| Your social security number | Text |
Enter your social security number. This should be a 9-digit number.
|
| (þÿ�f�1�_�4�9�[�0�]) | Text |
Enter the taxpayer's name.
|
| (þÿ�f�1�_�5�0�[�0�]) | Text |
Enter the taxpayer's Social Security Number (SSN).
|
| (þÿ�f�1�_�5�1�[�0�]) | Text |
Enter the spouse's name, if applicable.
|
| (þÿ�f�1�_�5�2�[�0�]) | Text |
Enter the spouse's Social Security Number (SSN), if applicable.
|
| Policy Allocation | ||
| (c) Allocation start month | Text |
Enter the month when the allocation of the policy starts.
|
| (d) Allocation stop month | Text |
Enter the month when the allocation of the policy stops.
|
| d) Allocation stop month | Text |
Enter the month when the allocation of the policy stops.
|
| (e) Premium Percentage | Text |
Enter the premium percentage for the policy.
|
| (f) SLCSP Percentage | Text |
Enter the Second Lowest Cost Silver Plan (SLCSP) percentage.
|
| (c) Allocation start month | Text |
Enter the month when the allocation of the policy starts.
|
| Allocation stop month | Text |
Enter the month when the allocation of the policy stops.
|
| (e) Premium Percentage | Text |
Enter the premium percentage for the policy.
|
| (f) SLCSP Percentage | Text |
Enter the Second Lowest Cost Silver Plan (SLCSP) percentage.
|
| (g) Advance Payment of the PTC Percentage | Text |
Enter the percentage of the advance payment of the Premium Tax Credit (PTC).
|
| (c) Allocation start month | Text |
Enter the month when the allocation of the policy starts.
|
| (d) Allocation stop | Text |
Enter the month when the allocation of the policy stops.
|
| (e) Premium Percentage | Text |
Enter the premium percentage for the policy.
|
| (f) SLCSP Percentage | Text |
Enter the Second Lowest Cost Silver Plan (SLCSP) percentage.
|
| (g) Advance Payment of the PTC Percentage | Text |
Enter the percentage of the advance payment of the Premium Tax Credit (PTC).
|
| Policy Amounts | ||
| (þÿ�f�1�_�4�6�[�0�]) | Text |
Enter the total policy amounts allocated.
|
| Policy Information | ||
| (þÿ�f�1�_�5�3�[�0�]) | Text |
Enter the number of individuals covered by the policy.
|
| (þÿ�f�1�_�5�4�[�0�]) | Text |
Enter the policy number.
|
| (þÿ�f�1�_�5�5�[�0�]) | Text |
Enter the start date of the policy.
|
| (þÿ�f�1�_�5�6�[�0�]) | Text |
Enter the end date of the policy.
|
| (þÿ�f�1�_�5�7�[�0�]) | Text |
Enter the total premium amount paid.
|
| (þÿ�f�1�_�5�8�[�0�]) | Text |
Enter the total premium amount covered by the advance payments.
|
| (þÿ�f�1�_�5�9�[�0�]) | Text |
Enter the total premium amount covered by the taxpayer.
|
| (þÿ�f�1�_�6�0�[�0�]) | Text |
Enter any additional policy-related information or notes.
|
| a) Policy Number (Form 1095-A, line 2) | Text |
Enter the policy number as shown on Form 1095-A, line 2.
|
| a) Policy Number (Form 1095-A, line 2) | Text |
Enter the policy number as shown on Form 1095-A, line 2.
|
| a) Policy Number (Form 1095-A, line 2) | Text |
Enter the policy number as shown on Form 1095-A, line 2.
|
| Policy Number (Form 1095-A, line 2) | Text |
Enter the policy number as shown on Form 1095-A, line 2.
|
| Premium Tax Credit | ||
| (þÿ�f�1�_�4�2�[�0�]) | Text |
Enter the total annual premium tax credit amount.
|
| (þÿ�f�1�_�4�4�[�0�]) | Text |
Enter the total premium tax credit amount claimed.
|
| Premium Tax Credit Calculation | ||
| 24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here | Text |
Enter the total premium tax credit amount. This is the amount from line 11(e) or the sum of lines 12(e) through 23(e).
|
| Taxpayer Information | ||
| (b) SSN of other taxpayer | Text |
Enter the Social Security Number (SSN) of the other taxpayer involved in the policy allocation.
|
| (b) SSN of other taxpayer | Text |
Enter the Social Security Number (SSN) of the other taxpayer involved in the policy allocation.
|
| (b) SSN of other taxpayer | Text |
Enter the Social Security Number (SSN) of the other taxpayer involved in the policy allocation.
|
| (b) SSN of other taxpayer | Text |
Enter the Social Security Number (SSN) of the other taxpayer involved in the policy allocation.
|