1. Form 8962 Premium Tax Credit
tax.idaho.gov

2. Your Social Security Number
Your Name
Your Social Security Number 1
1040NR Line 36
1040NR Line 36
Amount from Table X

4. Your Social Security Number
Your Name
Your Social Security Number 1
1040NR Line 36
1040NR Line 36
Amount from Table X
Amount from Table
If you are:
Single mark “No”
Married mark “Yes”
Line 3 ÷ Line 4
Do Not Round
Example:
= 57
= 133

6. Line 8a ÷ 12 Line 3 x Line 7 Round to Nearest Dollar
Your Name
Your Social Security Number 1
1040NR Line 36
1040NR Line 36
Amount from Table X
Amount from Table
Line 8a ÷ 12
Round to Nearest Dollar
Example:
= 11
= 8
Line 3 x Line 7
Round to Nearest Dollar
Example:
= 11
= 8

7. If you were the only person on your policy check
If you shared a policy with a spouse check “Yes”
If you had insurance for the entire year check “Yes”
If you did not have insurance for the entire year check “No”

8. Your Spouse’s ITIN Number Month Allocation Starts
If you checked “Yes” on line 9 and “Yes” on line 10 then go to page 2 of Form 8962
1095-A, Line 2
Your Spouse’s ITIN Number
Month Allocation Starts
Month Allocation Ends
0.50
0.50
0.50
January = 01
February = 02
March = 03
April = 04
May = 05
June = 06
July = 07
August = 08
September = 09
October = 10
November = 11
December = 12

9. If you checked “Yes” on Line 10 and are married but your spouse was not on your policy take the amount from your 1095-A, Line 33 Column C and enter it on Line 11 Column F

10. If you checked “Yes” on Line 10 and you are married and your spouse is on your policy take the amount from your 1095-A, Line 33 Column C Multiply it by .5 and enter it on Line 11 Column F
Multiply by 0.5

11. If you are Single and checked “No” on line 9 and “Yes” on line 10 then fill in Line 11 with the totals from your 1095-A

12. If you are married but your spouse was not on your policy take the amounts from your 1095-A, Column C and enter it on Column F

13. If you are married and your spouse was on your policy take the amounts from your 1095-A, Column C multiply it by 0.5 and enter it on Column F
Multiply by 0.5

14. If you are Single and checked “No” on line 9 and on Line 10 then fill in Lines 12 through 23 with amounts from your 1095-A Lines 21 through 32

15. V

16. _
Column B
Column C
Column D = _
Column B
Column C
Column D =

17. Enter the Smaller of Column A or Column D in Column E

20. If you are married enter the amount on line 25 onto line 27.

21. If line 24 is greater than line 25 then take line 24 minus line 25 and put the difference on line 26.
If line 25 is greater than line 24 then take line 25 minus line 24 and put the difference on line 27.

22. Amount from Table

23. Enter the smaller of Line 27 or Line 28 in Line 29
Amount from Table
Enter the smaller of Line 27 or Line 28 in Line 29

24. Form 1040NR Form 8962 Line 29 Sum of Line 42 and Line 44 Line 45

25. W-2
Box 2

27. W-2
Box 2
1042-S
Box 7

29. W-2
Box 2
1042-S
Box 7
Form 8962
Line 26
Sum of
Line 62a, Line 62d, and Line 65

30. If line 71 is greater than line 61 then take line 71 minus line 61 and put the difference on line 72 & line 73a.
If line 61 is greater than line 71 then take line 61 minus line 71 and put the difference on line 75.

31. Finishing the Return Sign & date Attach 8843, 8962, W-2 and 1042-S
Keep copy
Mail by April 15

32. Mail To: REFUND: Department of the Treasury
Internal Revenue Service Center
Austin, TX
TAX DUE:
Internal Revenue Service
P.O. Box 1303
Charlotte, NC