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Printable Form 14039 San Diego California: What You Should Know

Form FT 8962 The federal IRS Form 1095-A Health Insurance Marketplace Statement 路 3. The California Form FT 3895 California Health Insurance Marketplace Statement (for people who get a health plan from a health care plan), with the appropriate language for the federal tax code at line 7. 路 Use Form FT 3895 to get a health plan at a discounted price from a health care policy for which you are eligible; to pay the premium of your health plan; and to get health insurance for a child in which you are the head of the household. The Form 1095-B. Federal Marketplace Statement (for people with individual coverage) 路 4. The California Form FT 8962 California Health Insurance Marketplace Statement (for people who get individual coverage from an employer) to calculate the premium tax credit. 路 Use Form FT 8962 to figure the individual premium tax credit. 路 Use Form FT 8962 to reconcile the premium tax credit with advance payments of the premium tax credit. To prepare Form FT 8962, have your health plan provider complete and file Form FT 3895. California Forms FT 8962, SF 962, FT 8962B. Federal Marketplace Statement 路 5. The California Form FT 3895 California Health Insurance Marketplace Statement (for people who get individual coverage from an employer). (Note: It may be helpful to call your plan provider to review Form FT 3895 to ensure your plan meets the eligibility requirements.) 路 Use Form FT 3895 to figure the individual premium tax credit. (Note: It may be helpful to call your plan provider to review Form FT 3895 to ensure your plan meets the eligibility requirements.) 路 Use Form FT 3895 to reconcile the individual premium tax credit with advance payments of the individual premium tax credit. To prepare Form FT 8962, have your health plan provider complete and file Form FT 3895. The IRS Form 1095-B, Health Insurance Marketplace Statement (for people with individual coverage) 路 6. Use the California Form FT 8962 California Health Insurance Marketplace Statement, Form FT 3895, and the California Form FT 8962B and form FT 8962C to calculate the premium tax credit.

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