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Form 8962 Premium Tax Credit

Form 8962 Premium Tax Credit. Your Social Security Number. Your Name. 1. 1040NR Line 36. 0. 1040NR Line 36. Amount from Table. X. Your Social Security Number. Your Name. 1. 1040NR Line 36. 0. 1040NR Line 36. Amount from Table. X. Amount from Table. If you are: Single mark “No”

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Form 8962 Premium Tax Credit

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  1. Form 8962 Premium Tax Credit

  2. Your Social Security Number Your Name 1 1040NR Line 36 0 1040NR Line 36 Amount from Table X

  3. Your Social Security Number Your Name 1 1040NR Line 36 0 1040NR Line 36 Amount from Table X Amount from Table If you are: Single mark “No” Married mark “Yes” Line 3 ÷ Line 4 Do Not Round Example: .57841 = 57 1.33111 = 133

  4. Your Social Security Number Your Name 1 1040NR Line 36 0 1040NR Line 36 Amount from Table X Amount from Table Line 8a ÷ 12 Round to Nearest Dollar Example: 10.5698 = 11 8.1154 = 8 Line 3 x Line 7 Round to Nearest Dollar Example: 10.5698 = 11 8.1154 = 8

  5. If you were the only person on your policy check “No” If you shared a policy with a spouse check “Yes” If you had insurance for the entire year check “Yes” If you did not have insurance for the entire year check “No”

  6. If you checked “Yes” on line 9 and “Yes” on line 10 then go to page 2 of Form 8962 Your Spouse’s ITIN Number 1095-A, Line 2 Month Allocation Ends Month Allocation Starts 0.50 0.50 0.50 January = 01 February = 02 March = 03 April = 04 May = 05 June = 06 July = 07 August = 08 September = 09 October = 10 November = 11 December = 12

  7. If you checked “Yes” on Line 10 and are married but your spouse was not on your policy take the amount from your 1095-A, Line 33 Column C and enter it on Line 11 Column F

  8. If you checked “Yes” on Line 10 and you are married and your spouse is on your policy take the amount from your 1095-A, Line 33 Column C Multiply it by .5 and enter it on Line 11 Column F Multiply by 0.5

  9. If you checked “No” on line 9 and “Yes” on line 10 then fill in Line 11 with the totals from your 1095-A

  10. If you are married but your spouse was not on your policy take the amounts from your 1095-A, Column C and enter it on Column F

  11. If you are married and your spouse was on your policy take the amounts from your 1095-A, Column C multiply it by 0.5 and enter it on Column F Multiply by 0.5

  12. If you checked “No” on line 9 and “No” on Line 10 then fill in Lines 12 through 23 with the amounts from your 1095-A Lines 21 through 32

  13. V

  14. _ Column B Column C Column D = _ Column B Column C Column D =

  15. Smaller of Column A or Column D Equals Column E Smaller of Column A or Column D Equals Column E

  16. If you are married enter the amount on line 25 onto line 27.

  17. If line 24 is greater than line 25 then take line 24 minus line 25 and put the difference on line 26. If line 25 is greater than line 24 then take line 25 minus line 24 and put the difference on line 27.

  18. Amount from Table

  19. Amount from Table Enter the smaller of Line 27 or Line 28 in Line 29

  20. Form 1040NR Form 8962 Line 29 Sum of Line 42 and Line 44 Line 45 Line 53

  21. W-2 Box 2

  22. W-2 Box 2 1042-S Box 7

  23. W-2 Box 2 1042-S Box 7 Form 8962 Line 26 Sum of Line 62a, Line 62d, and Line 65

  24. If line 71 is greater than line 61 then take line 71 minus line 61 and put the difference on line 72 & line 73a. If line 61 is greater than line 71 then take line 61 minus line 71 and put the difference on line 75.

  25. Sign & date • Attach 8843, 8962, W-2 and 1042-S • Keep copy • Mail by April 17 Finishing the Return

  26. REFUND: Department of the Treasury Internal Revenue Service Center Austin, TX 73301-0215 TAX DUE: Internal Revenue Service P.O. Box 1303 Charlotte, NC 28201-1303 Mail To:

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