Form 1099-H Template

Use this form to record Health Coverage Tax Credit advance payments made for a recipient during the year.

By using this template, you agree to our Template Terms of Use.

Why use a Form 1099-H?

A Form 1099-H helps document issuer, recipient, total payment, month count, and monthly HCTC payment details.

Track HCTC payments

Record the total amount of HCTC advance payments made during the calendar year.
Show monthly amounts

Use monthly fields from January through December to organize payment details.
Identify issuer and recipient

Keep issuer, provider, recipient, and taxpayer identification details in one form.

This template includes issuer details, recipient information, total HCTC amounts, and monthly payment boxes.

Issuer or provider details
Fields capture issuer or provider name, address, telephone number, and TIN.
Recipient information
Includes recipient name, address, and taxpayer identification number fields.
Total advance payments
Provides a field for the full amount of HCTC advance payments for the year.
Monthly payment fields
Includes separate boxes for HCTC payments received from January through December.
Copy and correction fields
Includes Copy A, Copy B, calendar year, corrected, and void indicators.