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Federal forms, ICRs, and supporting documents

OMB control number

The Health Coverage Tax Credit (HCTC) Reimbursement Request Form

OMB 1545-2152 · TREAS/IRS.

OMB 1545-2152

This form will be used by HCTC participants to request reimbursement for health plan premiums paid prior to the commencement of advance payments.

The latest form for The Health Coverage Tax Credit (HCTC) Reimbursement Request Form expires 2022-02-28 and can be found here.

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