Header
Name of taxpayer and tax period ending.
14950
Premium Tax Credit Verification
- Agency
- IRS
- Revision
- Rev. 6-2024
- Fillable fields
- 3
- Pages
- 1
- Official source
- IRS form page
- Checked
- October 21, 2026
Form 14950: Premium Tax Credit Verification
Form 14950, Premium Tax Credit Verification, is a one-page IRS list of the documents to send when the IRS asks to verify the Premium Tax Credit (PTC) shown on a return. The form opens: "We need to verify that you are eligible to claim the Premium Tax Credit (PTC) shown on your return."
The top of the form has spaces for the name of taxpayer and the tax period ending. Below are a note on Marketplace coverage and a "What You Should Send Us" list: Form 8962, Forms 1095-A, 1095-B and 1095-C, records of who was covered, information behind Parts 4 and 5 of Form 8962, and proof that premiums were paid.
The form says that if the necessary records were not kept, the IRS suggests contacting the health insurance marketplace, insurance providers, plan administrators or financial institutions. You can fill in the header free in your browser on this page and download the form without an account.
What's on Form 14950
Verification notice and Marketplace note
The request to verify the PTC, and the note that coverage was purchased through a Health Insurance Marketplace, also known as an Exchange, such as healthcare.gov or a State Marketplace.
Form 8962
A completed copy if Form 8962 was not included with the return, or an updated copy if the one filed was not completed accurately.
Forms 1095-A, 1095-B and 1095-C
Form 1095-A, Health Insurance Marketplace Statement, plus Form 1095-B from an insurance provider and Form 1095-C from an employer if they were issued.
Form 8962 Parts 4 and 5 support
Allocated policy number, allocation SSN, allocation percentages and start and stop months for Part 4, and alternative family size, start and stop months and date of marriage for Part 5.
Coverage and payment records
Records naming the individuals covered, such as enrollment forms, invoices or statements, and proof of premiums paid.
How to complete Form 14950
- 1
Fill in the header
Enter the name of taxpayer and the tax period ending at the top of the form.
- 2
Review Form 8962
If Form 8962 was not included with the return, the form asks for a completed copy. If it was, the form says to review it and send an updated copy if it was not completed accurately.
- 3
Gather the 1095 forms
Include Form 1095-A, and Forms 1095-B or 1095-C if issued. If Form 1095-A did not arrive or seems incorrect, the form suggests contacting the Health Insurance Marketplace for a new or corrected copy.
- 4
Show who was covered
Add records showing the names of the individuals for whom the PTC is claimed, such as insurance enrollment forms, invoices or insurer statements.
- 5
Support Parts 4 and 5
If Form 8962 has entries in Part 4 or Part 5, add the shared policy allocation or year of marriage information the form lists.
- 6
Prove premiums were paid
The form accepts copies of both sides of cancelled checks, paid receipts, certificates of group health plan coverage, credit card statements, or bank records showing direct debit of the payments.
Why fill Form 14950 on indox
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Where it goes and what to watch
Who receives it
The list is titled "What You Should Send Us," meaning the IRS. The form prints no mailing address.
Missing records
The form suggests contacting the health insurance marketplace, insurance providers, plan administrators or financial institutions if the necessary records were not kept.
Marketplace coverage
The form says the PTC applies to health insurance purchased through a Health Insurance Marketplace, including healthcare.gov or a State Marketplace.
Form 8962
The form says Form 8962 is filed if advance payments of the premium tax credit were paid on the taxpayer's behalf or the credit is claimed.
Revision
The header prints June 2024 and the footer prints Form 14950 (Rev. 6-2024).
Related forms
Who uses Form 14950?
The form is addressed to a taxpayer whose return shows the PTC and whom the IRS asks to verify the claim. The taxpayer sends the documents to the IRS.
Official sources and the blank
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Questions about Form 14950
Who receives Form 14950 and the documents?
The IRS. The form's list is titled "What You Should Send Us" and the form prints no mailing address.
What if Form 8962 was not filed with the return?
The form asks for a completed copy of Form 8962, Premium Tax Credit.
What if Form 1095-A never arrived or looks wrong?
The form suggests contacting the Health Insurance Marketplace to obtain a new or corrected copy.
What counts as proof that premiums were paid?
The form lists copies of both sides of cancelled checks, paid receipts, certificates of group health plan coverage, credit card statements, or bank records showing direct debit of the payments.
Does coverage bought outside a Marketplace count?
The form says that if health insurance was not purchased from a Health Insurance Marketplace, the taxpayer is not eligible for the Premium Tax Credit.