Specific Instructions for Form 1099-H
File Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments, with the IRS by February 2, 2004, if you received in the course of
your trade or business any advance payments during the calendar year of qualified health insurance payments for the benefit
of eligible trade
adjustment assistance (TAA), alternative TAA, or Pension Benefit Guaranty Corporation (PBGC) recipients.
Section 6050T requires that the providers of qualifying health care coverage (defined in section 35(e)) file information returns
with the IRS
reporting the advance payments received from the Department of the Treasury on behalf of eligible individuals.
If you are required to file Form 1099-H, you must furnish a statement to the recipient. Provide a copy of Form 1099-H or an
acceptable substitute
statement to each recipient for whom you received any advance payments. Also, see part H in the 2003 General Instructions for Forms
1099, 1098, 5498, and W-2G.
Box 1. Amount of Health Insurance Advance Payments
Enter the total amount of advance payments of health insurance premiums received on behalf of the recipient beginning June
1, 2003, through
December 31, 2003.
Box 2. No. of Months HCTC Advance Payments Received
Enter the number of months for which payments were received on behalf of the recipient. For 2003, this number cannot be more
than 7.
Boxes 3-14. Amount of Advance Payment(s) Included in Box 1
Enter the amount of the advance payment received for each month in the applicable box. You may receive these payments prior
to the month for which
they are paid. Be sure to enter the amounts in the correct box. For example, if you receive an advance payment of $1,000 for
TAA “X” on December
12, 2003, for January 2004 medical insurance premium, then report the $1,000 payment on Form 1099-H for January 2004, not
December 2003.
