Instructions
Who uses the coupon and Steps 1 to 4: complete the information, print the document, cut off the coupon and send it with the payment.
13973
Health Coverage Tax Credit (HCTC) Blank Payment Coupon
- Agency
- IRS
- Revision
- Rev. 11-2016
- Fillable fields
- 23
- Pages
- 1
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 13973: Health Coverage Tax Credit (HCTC) Blank Payment Coupon
Form 13973 is the Health Coverage Tax Credit (HCTC) Blank Payment Coupon. The form says to use it if you received a notification letter from the IRS stating you have successfully enrolled in the HCTC Program. The participant fills in the coupon and mails it with a payment to US Treasury - HCTC.
The one-page form starts with instructions in four steps and a block for the HCTC Participant Identification Number (entered twice), participant name, street address, city, state and Zip, and amount paid. The form says the Participant Identification Number is at the top of the enrollment notification letter, and that completing Step 1 before printing fills in the coupon below. The bottom of the page is the payment coupon to cut off and send.
The PDF can be filled out free in the browser on this page and downloaded without an account.
What's on Form 13973
Step 1 information block
HCTC Participant Identification Number, the same number re-entered, participant name, street address, city, state and Zip, and amount paid.
Payment Details
The payment methods accepted by mail, who the check is payable to, and rules on U.S. banks and post-dated checks.
Privacy Act and Paperwork Reduction Act notice
The legal basis for collecting the information and an estimated average time of 10 minutes to complete the form.
Payment coupon
The cut-off coupon repeating the participant details and amount paid, with the payee name and mailing address.
How to fill out Form 13973
- 1
Participant Identification Number
Enter the HCTC Participant Identification Number from the top of the enrollment notification letter, then re-enter it in the next field.
- 2
Name, address and amount
Enter the participant name, street address, city, state and Zip, and the amount paid. The form says completing Step 1 before printing fills in the coupon below.
- 3
Print and cut
Print the document and cut off the payment coupon along the line shown.
- 4
Prepare the payment
Make the check payable to US Treasury - HCTC and write the HCTC Participant Identification Number on it. The form says checks are to be drawn from a bank within the United States.
- 5
Mail it
Send the coupon with the payment to US Treasury - HCTC, P.O. Box 970023, St. Louis, MO 63197-0023. The coupon says not to send cash and not to fold, staple or paper clip it.
Why fill Form 13973 on indox
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- The official blank straight from the IRS, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it and payment rules
Where to send
US Treasury - HCTC, P.O. Box 970023, St. Louis, MO 63197-0023, as printed on the form.
Accepted payments
Personal check, business check, certified check, cashier's check and money order by mail. The coupon says do not send cash.
Post-dated checks
The form says checks are processed upon receipt and post-dated checks will not be held for a later deposit.
Missing information
The form says failure to provide all required information could delay processing of the payment.
Handling the coupon
The coupon says not to write below the line and not to fold, staple or paper clip it.
Related forms
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ACH Vendor/Miscellaneous Payment Enrollment - HCTC
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Health Coverage Tax Credit (HCTC) Advance Payments
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Who uses Form 13973?
The coupon is filled out by an HCTC participant who is paying by mail. It goes to US Treasury - HCTC, not to an IRS service center.
Official sources and the blank
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Questions about Form 13973
Who uses Form 13973?
The form says to use it if you received a notification letter from the IRS stating you have successfully enrolled in the HCTC Program.
Where is the HCTC Participant Identification Number?
The form says it is at the top of the enrollment notification letter.
Who is the check made payable to?
US Treasury - HCTC, according to the form. The HCTC Participant Identification Number goes on the check.
Can the payment be made in cash?
No. The coupon says do not send cash. The form lists personal check, business check, certified check, cashier's check and money order.
Where is Form 13973 mailed?
To US Treasury - HCTC, P.O. Box 970023, St. Louis, MO 63197-0023.
Will a post-dated check be held?
No. The form says checks are processed upon receipt and post-dated checks will not be held for a later deposit.