Get the free Form 8963 (Rev. January 2018). Report of Health Insurance Provider Information
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Page 1 of 2 Foreparts of Health Insurance Provider Information OMB Number 15452249 Read the instructions before you complete Form 8963. Go to www.irs.gov/Form8963 for instructions and the latest information.
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What is form 8963 rev january?
Form 8963 rev january is the Report of Health Insurance Provider Fees issued by the Internal Revenue Service (IRS).
Who is required to file form 8963 rev january?
Health insurance providers are required to file form 8963 rev january if they are subject to the Health Insurance Provider Fee.
How to fill out form 8963 rev january?
Form 8963 rev january must be filled out accurately with information regarding the health insurance provider's fees and payments.
What is the purpose of form 8963 rev january?
The purpose of form 8963 rev january is to report and calculate the health insurance provider fees that are required under the Affordable Care Act.
What information must be reported on form 8963 rev january?
Information such as the health insurance provider's name, address, FEIN, covered lives, net premiums written, and the amount of the health insurance provider fee must be reported on form 8963 rev january.
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