Printable blank Form 13441-A

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1. What is 13441-A form?

The fillable 13441-A form focuses on the health coverage tax credit or HCTC. The form is used for the monthly registration and update. Usually, you have to download the 13441-A form to file it to the HCTC program. You are required to send the copy to the IRS. This tax form requires the health insurance bill as well.

2. What I need the 13441-A for?

  • Use the blank with a 13441-A form to state your current HCTC state. This is a monthly business, and you have to send it regularly;
  • You have to confirm the eligibility if you want to receive further services;
  • If you are a member of the family of the HCTC eligible individual and you want to receive HCTC;
  • You need to notify the IRS of the current bills from insurance no older than the last 60 days.

3. How to fill out a 13441-A form?

This website contains pdf documents that you may easily download on your computer. It is totally free of charge. You can also fill the form online. However, it is recommended to print the copy and to learn which other documents you may need to attach and how to complete the 13441-A form:

  • There are 4 pages of the document, but you have to complete only 3 of them;
  • On the first page, you will see the documents that you should attach to the form, including the insurance bill within the last 60 days, COBRA election letter if you have COBRA, a letter from a former employer if you have no group coverage;
  • Part 1 asks for your general information, including name, address;
  • Part 2 is for confirmation of your eligibility;
  • Part 3 is for the information about a family member that wants to use HCTC services;
  • Part 4 is for the information on health plant;
  • Part 5 is for the account accessibility;
  • Part 6 is form completion, where you have to put your signature.

4. Organizations that work with 13441-A

  • You have to send it to the IRS.

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