Instructions for Recipient
This statement is provided to you because you received
Health Coverage Tax Credit (HCTC) advance payments
of your health coverage insurance premiums. These
advance payments were forwarded directly to your
health insurance provider. You are qualified to receive
advance payments if you were an eligible trade
adjustment assistance (TAA) recipient, an Alternative
TAA (ATAA) recipient, a Reemployment TAA (RTAA)
recipient, or a Pension Benefit Guaranty Corporation
(PBGC) pension payee. See Form 8885, Health
Coverage Tax Credit, and its instructions for more
details on qualified recipients and how to figure any
credit that you may be able to take on your Form 1040,
1040NR, 1040-SS, or 1040-PR.
Recipient’s taxpayer identification number (TIN).
For your protection, this form may show only the last
four digits of your TIN (social security number (SSN),
individual taxpayer identification number (ITIN), or
adoption taxpayer identification number (ATIN)).
However, the issuer has reported your complete TIN to
Box 1. Shows the total amount of HCTC advance
payments of qualified health insurance costs that were
made on your behalf.
Box 2. Shows the total number of months you received
Boxes 3 through 14. Shows the amount of HCTC
advance payments paid for you for each month. The
total of the amounts shown in these boxes equals the
amount shown in box 1.
For the latest information about developments related to
Form 1099-H and its instructions, such as legislation
enacted after they were published, go to