Fillable ATS Test Scenario 1 Taxpayer: Morgan Gardner SSN: (IRS)

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ATS Test Scenario 1 Taxpayer: Morgan Gardner SSN: (IRS)

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ATS Test Scenario 1
Taxpayer: Morgan Gardner
SSN: 400-00-1037
Test Scenario 1 includes the following forms:
• Form 1040
• Form 1040 Schedule 1
• Form 1040 Schedule 3
• Form W-2
• Form 8962
Additional information:
Taxpayer's Date of Birth = July 8, 1979
Form 8962
Assume entries are correct for line 11- A, B, F
August 18, 2020
DO NOT FILE
DRAFT AS OF
DRAFT AS OF
Form
1040
2020
U.S. Individual Income Tax Return
Department of the Treasury—Internal Revenue Service
(99)
OMB No. 1545-0074
IRS Use Only—Do not write or staple in this space.
Filing Status
Check only
one box.
Single Married filing jointly
Married filing separately (MFS)
Head of household (HOH)
Qualifying widow(er) (QW)
If you checked the MFS box, enter the name of your spouse. If you checked the HOH or QW box, enter the child’s name if the qualifying
person is a child but not your dependent
a
Your first name and middle initial Last name Your social security number
If joint return, spouse’s first name and middle initial Last name
Spouse’s social security number
Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
City, town, or post office. If you have a foreign address, also complete spaces below.
State ZIP code
Foreign country name Foreign province/state/county
Foreign postal code
Presidential Election Campaign
Check here if you, or your
spouse if filing jointly, want $3
to go to this fund. Checking a
box below will not change
your tax or refund.
You
Spouse
At any time during 2020, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?
Yes No
Standard
Deduction
Someone can claim: You as a dependent Your spouse as a dependent
Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness
You:
Were born before January 2, 1956
Are blind Spouse:
Was born before January 2, 1956
Is blind
Dependents
(see instructions):
If more
than four
dependents,
see instructions
and check
here
a
(2) Social security
number
(3) Relationship
to you
(4) if qualifies for (see instructions):
(1) First name Last name
Child tax credit
Credit for other dependents
1 Wages, salaries, tips, etc. Attach Form(s) W-2 ................ 1
Attach
Sch. B if
required.
2a Tax-exempt interest . . . 2a
b Taxable interest .....
2b
3a Qualified dividends . . . 3a
b Ordinary dividends .....
3b
4a IRA distributions .... 4a b Taxable amount ...... 4b
5a Pensions and annuities . . 5a b Taxable amount ...... 5b
6a Social security benefits . . 6a b Taxable amount ...... 6b
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here ....
a
7
8 Other income from Schedule 1, line 9 ................... 8
9 Add lines 1, 2b, 3b, 4b, 5b, 6b, 7, and 8. This is your total income .........
a
9
10 Adjustments to income:
a From Schedule 1, line 22 ..............
10a
b
Charitable contributions if you take the standard deduction. See instructions
10b
c Add lines 10a and 10b. These are your total adjustments to income ........
a
10c
11 Subtract line 10c from line 9. This is your adjusted gross income .........
a
11
12 Standard deduction or itemized deductions (from Schedule A) ..........
Standard
Deduction for—
• Single or
Married filing
separately,
$12,400
• Married filing
jointly or
Qualifying
widow(er),
$24,800
• Head of
household,
$18,650
•
If you checked
any box under
Standard
Deduction,
see instructions.
12
13 Qualified business income deduction. Attach Form 8995 or Form 8995-A ........ 13
14 Add lines 12 and 13 ........................ 14
15 Taxable income. Subtract line 14 from line 11. If zero or less, enter -0- .........
15
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 11320B
Form 1040 (2020)
✔
Morgan
Gardner
400001037
2250 W. Sahara Ave
Las Vegas
NV
89146
✔
August 18, 2020
DO NOT FILE
DRAFT AS OF
Form 1040 (2020)
Page 2
16
Tax (see instructions). Check if any from Form(s):
1 8814 2 4972 3
..
16
17 Amount from Schedule 2, line 3 .................... 17
18 Add lines 16 and 17 ........................ 18
19 Child tax credit or credit for other dependents ................ 19
20 Amount from Schedule 3, line 7 .................... 20
21 Add lines 19 and 20 ........................ 21
22 Subtract line 21 from line 18. If zero or less, enter -0- .............. 22
23 Other taxes, including self-employment tax, from Schedule 2, line 10 ......... 23
24 Add lines 22 and 23. This is your total tax ................
a
24
25 Federal income tax withheld from:
a Form(s) W-2 ..................
25a
b Form(s) 1099 .................. 25b
c Other forms (see instructions) ............. 25c
d Add lines 25a through 25c ...................... 25d
26 2020 estimated tax payments and amount applied from 2019 return .......... 26
27 Earned income credit (EIC) ..............
•
If you have a
qualifying child,
attach Sch. EIC.
•
If you have
nontaxable
combat pay,
see instructions.
27
28 Additional child tax credit. Attach Schedule 8812 ....... 28
29 American opportunity credit from Form 8863, line 8 . ...... 29
30 Recovery rebate credit. See instructions .......... 30
31 Amount from Schedule 3, line 13 ............ 31
32
Add lines 27 through 31. These are your total other payments and refundable credits ...
a
32
33 Add lines 25d, 26, and 32. These are your total payments ...........
a
33
Refund
34 If line 33 is more than line 24, subtract line 24 from line 33. This is the amount you overpaid .. 34
35a Amount of line 34 you want refunded to you. If Form 8888 is attached, check here . . .
a
35a
Direct deposit?
See instructions.
a
b
Routing number
a
c Type: Checking Savings
a
d
Account number
36
Amount of line 34 you want applied to your 2021 estimated tax
..
a
36
Amount
You Owe
For details on
how to pay, see
instructions.
37
Subtract line 33 from line 24. This is the amount you owe now ..........
a
37
Note: Schedule H and Schedule SE filers, line 37 may not represent all of the taxes you owe for
2020. See Schedule 3, line 12e, and its instructions for details.
38 Estimated tax penalty (see instructions) .........
a
38
Third Party
Designee
Do you want to allow another person to discuss this return with the IRS? See
instructions ....................
a
Yes. Complete below. No
Designee’s
name
a
Phone
no.
a
Personal identification
number (PIN)
a
Sign
Here
Joint return?
See instructions.
Keep a copy for
your records.
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature Date Your occupation
If the IRS sent you an Identity
Protection PIN, enter it here
(see inst.)
a
Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation
If the IRS sent your spouse an
Identity Protection PIN, enter it here
(see inst.)
a
Phone no.
Email address
F
Paid
Preparer
Use Only
Preparer’s name
Preparer’s signature Date
PTIN
Check if:
Self-employed
Firm’s name
a
Phone no.
Firm’s address
a
Firm’s EIN
a
Go to www.irs.gov/Form1040 for instructions and the latest information.
Form 1040 (2020)
012345672
✔
40525376
August 18, 2020
DO NOT FILE
DRAFT AS OF
SCHEDULE 1
(Form 1040)
Department of the Treasury
Internal Revenue Service
Additional Income and Adjustments to Income
a
Attach to Form 1040, 1040-SR, or 1040-NR.
a
Go to www.irs.gov/Form1040 for instructions and the latest information.
OMB No. 1545-0074
2020
Attachment
Sequence No.
01
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
Part I Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes ....... 1
2a Alimony received ........................... 2a
b
Date of original divorce or separation agreement (see instructions)
a
3 Business income or (loss). Attach Schedule C ............... 3
4 Other gains or (losses). Attach Form 4797 ................. 4
5
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
5
6 Farm income or (loss). Attach Schedule F ................. 6
7 Unemployment compensation ...................... 7
8
Other income. List type and amount
a
8
9
Combine lines 1 through 8. Enter here and on Form 1040, 1040-SR, or 1040-NR,
line 8 ................................ 9
Part II Adjustments to Income
10 Educator expenses .......................... 10
11
Certain business expenses of reservists, performing artists, and fee-basis government
officials. Attach Form 2106 . . .....................
11
12 Health savings account deduction. Attach Form 8889 ............ 12
13 Moving expenses for members of the Armed Forces. Attach Form 3903 ..... 13
14 Deductible part of self-employment tax. Attach Schedule SE ......... 14
15 Self-employed SEP, SIMPLE, and qualified plans .............. 15
16 Self-employed health insurance deduction ................. 16
17 Penalty on early withdrawal of savings .................. 17
18a Alimony paid ............................. 18a
b Recipient’s SSN ....................
a
c
Date of original divorce or separation agreement (see instructions)
a
19 IRA deduction ............................ 19
20 Student loan interest deduction ..................... 20
21 Tuition and fees deduction. Attach Form 8917 ............... 21
22
Add lines 10 through 21. These are your adjustments to income. Enter here and
on Form 1040, 1040-SR, or 1040-NR, line 10a ............... 22
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 71479F Schedule 1 (Form 1040) 2020
Morgan Gardner
400-00-1037
250
108
August 18, 2020
DO NOT FILE
DRAFT AS OF
SCHEDULE 3
(Form 1040)
2020
Additional Credits and Payments
Department of the Treasury
Internal Revenue Service
a
Attach to Form 1040, 1040-SR, or 1040-NR.
a
Go to www.irs.gov/Form1040 for instructions and the latest information.
OMB No. 1545-0074
Attachment
Sequence No.
03
Name(s) shown on Form 1040, 1040-SR, or 1040-NR Your social security number
Part I
Nonrefundable Credits
1 Foreign tax credit. Attach Form 1116 if required .............. 1
2 Credit for child and dependent care expenses. Attach Form 2441 ....... 2
3 Education credits from Form 8863, line 19 ................. 3
4 Retirement savings contributions credit. Attach Form 8880 .......... 4
5 Residential energy credits. Attach Form 5695 ............... 5
6 Other credits from Form: a 3800 b 8801 c 6
7 Add lines 1 through 6. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 20
7
Part II
Other Payments and Refundable Credits
8 Net premium tax credit. Attach Form 8962 ................. 8
9 Amount paid with request for extension to file (see instructions) ........ 9
10 Excess social security and tier 1 RRTA tax withheld ............. 10
11 Credit for federal tax on fuels. Attach Form 4136 .............. 11
12 Other payments or refundable credits:
a Form 2439 .....................
12a
b
Qualified sick and family leave credits from Schedule(s) H and
Form(s) 7202 ....................
12b
c Health coverage tax credit from Form 8885 ........ 12c
d Other: 12d
e Deferral for certain Schedule H or SE filers (see instructions) . 12e
f Add lines 12a through 12e ....................... 12f
13
Add lines 8 through 12f. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 31
13
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 71480G Schedule 3 (Form 1040) 2020
Morgan Gardner
400-00-1037
a Employee’s social security number
OMB No. 1545-0008
Safe, accurate,
FAST! Use
Visit the IRS website at
www.irs.gov/efile
b Employer identification number (EIN)
c Employer’s name, address, and ZIP code
d Control number
e Employee’s first name and initial Last name Suff.
f Employee’s address and ZIP code
1 Wages, tips, other compensation
2 Federal income tax withheld
3 Social security wages 4 Social security tax withheld
5 Medicare wages and tips 6 Medicare tax withheld
7 Social security tips 8 Allocated tips
9 10 Dependent care benefits
11 Nonqualified plans 12a See instructions for box 12
C
o
d
e
12b
C
o
d
e
12c
C
o
d
e
12d
C
o
d
e
13
Statutory
employee
Retirement
plan
Third-party
sick pay
14 Other
15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20
Locality name
Form
W-2
Wage and Tax Statement
2020
Copy B—To Be Filed With Employee’s FEDERAL Tax Return.
This information is being furnished to the Internal Revenue Service.
Department of the Treasury—Internal Revenue Service
XYZ Water Works
393 S. 14th Street
Las Vegas, NV 89101
Morgan Gardner
2250 W. Sahara Avenue
Las Vegas, NV 89146
35,952
35,952
35,952
4,600
2,229
521
00-0000057
400-00-1037
August 19, 2020
DO NOT FILE
DRAFT AS OF
Form 8962
Department of the Treasury
Internal Revenue Service
Premium Tax Credit (PTC)
a
Attach to Form 1040, 1040-SR, or 1040-NR.
a
Go to www.irs.gov/Form8962 for instructions and the latest information.
OMB No. 1545-0074
2020
Attachment
Sequence No.
73
Name shown on your return Your social security number
You 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 . .
a
Part I Annual and Monthly Contribution Amount
1 Tax family size. Enter your tax family size. See instructions ................. 1
2a Modified AGI. Enter your modified AGI. See instructions ......... 2a
b Enter the total of your dependents’ modified AGI. See instructions ...... 2b
3 Household income. Add the amounts on lines 2a and 2b. See instructions ............ 3
4
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 used. a Alaska b Hawaii c Other 48 states and DC 4
5
Household income as a percentage of federal poverty line (see instructions) . . ..........
5 %
6 Did you enter 401% on line 5? (See instructions if you entered less than 100%.)
No. Continue to line 7.
Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for
how to report your excess advance PTC repayment amount.
7
Applicable figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions . .
7
8
a
Annual contribution amount. Multiply line 3 by
line 7. Round to nearest whole dollar amount
8a
b
Monthly contribution amount. Divide line 8a
by 12. Round to nearest whole dollar amount
8b
Part II 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. Continue to line 10.
10 See the instructions to determine if you can use line 11 or must complete lines 12 through 23.
Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23
and continue to line 24.
No. Continue to lines 12–23. Compute
your monthly PTC and continue to line 24.
Annual
Calculation
(a) Annual enrollment
premiums (Form(s)
1095-A, line 33A)
(b) Annual applicable
SLCSP premium
(Form(s) 1095-A,
line 33B)
(c) Annual
contribution amount
(line 8a)
(d) Annual maximum
premium assistance
(subtract (c) from (b); if
zero or less, enter -0-)
(e) Annual premium tax
credit allowed
(smaller of (a) or (d))
(f)
Annual advance
payment of PTC (Form(s)
1095-A, line 33C)
11
Annual Totals
Monthly
Calculation
(a) Monthly enrollment
premiums (Form(s)
1095-A, lines 21–32,
column A)
(b) Monthly applicable
SLCSP premium
(Form(s) 1095-A, lines
21–32, column B)
(c) Monthly
contribution amount
(amount from line 8b
or alternative marriage
monthly calculation)
(d) Monthly maximum
premium assistance
(subtract (c) from (b); if
zero or less, enter -0-)
(e) Monthly premium tax
credit allowed
(smaller of (a) or (d))
(f)
Monthly advance
payment of PTC (Form(s)
1095-A, lines 21–32,
column C)
12 January
13 February
14 March
15 April
16 May
17 June
18 July
19 August
20 September
21 October
22 November
23 December
24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24
25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25
26
Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and
on Schedule 3 (Form 1040), line 8. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24,
leave this line blank and continue to line 27 .....................
26
Part III Repayment of Excess Advance Payment of the Premium Tax Credit
27
Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here
27
28 Repayment limitation (see instructions) ...................... 28
29
Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2
(Form 1040), line 2 ............................
29
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 37784Z
Form 8962 (2020)
Morgan Gardner
400-00-1037
1
36,094
0
✔
✔
✔
8,400
9,300
5,700
August 19, 2020
DO NOT FILE
DRAFT AS OF
Form 8962 (2020)
Page 2
Part IV Allocation of Policy Amounts
Complete the following information for up to four policy amount allocations. See instructions for allocation details.
Allocation 1
30
(a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer
(c) Allocation start month
(d) Allocation stop month
Allocation percentage
applied to monthly
amounts
(e) Premium Percentage (f) SLCSP Percentage
(g) Advance Payment of the PTC
Percentage
Allocation 2
31
(a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month
Allocation percentage
applied to monthly
amounts
(e) Premium Percentage (f) SLCSP Percentage
(g) Advance Payment of the PTC
Percentage
Allocation 3
32
(a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month
Allocation percentage
applied to monthly
amounts
(e) Premium Percentage (f) SLCSP Percentage
(g) Advance Payment of the PTC
Percentage
Allocation 4
33
(a) Policy Number (Form 1095-A, line 2) (b) SSN of other taxpayer (c) Allocation start month (d) Allocation stop month
Allocation percentage
applied to monthly
amounts
(e) Premium Percentage (f) SLCSP Percentage
(g) Advance Payment of the PTC
Percentage
34 Have you completed all policy amount allocations?
Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and non-
allocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on
lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24.
No. See the instructions to report additional policy amount allocations.
Part V Alternative Calculation for Year of Marriage
Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9.
To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V.
35
Alternative entries
for your SSN
(a) Alternative family size (b) Alternative monthly
contribution amount
(c) Alternative start month (d) Alternative stop month
36
Alternative entries
for your spouse’s
SSN
(a) Alternative family size
(b) Alternative monthly
contribution amount
(c) Alternative start month (d) Alternative stop month
Form 8962 (2020)
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ATS Test Scenario 1 Taxpayer: Morgan Gardner SSN: (IRS)

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Completed 4 February 2022

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