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2017 Form 8962 - IRS tax forms

form 8962 Department of the Treasury Internal Revenue ServicePremium tax credit (PTC) Attach to form 1040, 1040A, or 1040NR. Go to for instructions and the latest No. 1545-00742017 Attachment Sequence No. 73 Name shown on your returnYour social security numberYou 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 IAnnual and Monthly Contribution Amount 1 Tax family size. Enter the number of exemptions from form 1040 or form 1040A, line 6d, or form 1040NR, line 7d 12aModified AGI. Enter your modified AGI (see instructions)..2abEnter the total of your dependents' modified AGI (see instructions)..2b3 Household income. Add the amounts on lines 2a and 2b (see instructions) ..34 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 Alaska bHawaiicOther 48 states and DC45 Household income as a percentage of federal poverty line (see instructions).

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.

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