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Printable Form 1094-C Sunnyvale California: What You Should Know

Affordable Care Act and may not be used for certain exemptions. Form 1095-C is a tax form for reporting the monthly premium for a qualified health plan. It is often called a “premium tax credit.” The amount of the credit allowed is dependent on how much you earn, as shown on your W-2. If you file a joint tax return, your total federal income taxes may be taxed based on the combined total for your two tax returns. If you meet these criteria, you may have two different federal credits, one for each return. Federal income tax laws do not allow individuals to claim any federal health care expenses that exceed 10% of a taxpayer's adjusted gross income for the year. An individual should not use 1094-C if the individual does have health care expenses to report. Federal income tax laws do not allow an individual to claim cost sharing reductions (CSR) for qualified health plans. The taxpayer may use a non-certified Form 3903 to report these expenditures. For additional information on how to report cost sharing reduction amounts see the Publication 1349 (PDF page 1 of 18) If you received a Form 1095 in the mail from your employer, it indicates this amount will be included as a cost-sharing reduction for this year. Form 1094-C must be signed, notarized, notarized under penalties of perjury by the individual reporting the information to the IRS. If notarizing the form, you should obtain copies of the Forms W-2 and 1099 for this year which you sent to your employer. You should also keep a copy for your personal records. The individual signing the form should sign his or her name and date of birth. The form should clearly state that the individual is the employer-provider and that Form 1094 is filed by the individual. If the individual has not filled out the Form 1094-C, the person who signed it must sign it. The individual signing the form should also indicate that any information provided is accurate. The individual signing the form should add the following sentence: “I acknowledge that the information I am providing to the IRS is true and correct.” The IRS cannot accept a form 1094-C that does not accurately record the information provided on that form. A Form 1094-C that has not been completed or filed correctly is an invalid Form 1094-C and will not be accepted by the IRS.

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