John Sample & Jane Sample · 2025Revision 68 Certification not current Form 8867 Premium Tax Credit Schedule 1, 6251 & 8889 Payments Print package Form 1095-A and Form 8962Reconcile monthly marketplace premiums, SLCSP amounts, advance credits, household MAGI, and reviewed statutory exceptions.
Marketplace coverage applies Household size Other household modified AGI Federal poverty line State Household members reconciled Shared policies reviewed Below-poverty exception None Marketplace estimated at least 100% FPL Below-poverty exception reviewed MFS exception None Domestic abuse Spousal abandonment MFS exception reviewed Marriage alternative applies Marriage alternative reviewed Marriage month
Available record identifiers People: Jane Sample (spouse)=50000000-0000-4000-8000-000000000002; John Sample (taxpayer)=50000000-0000-4000-8000-000000000001 1095-A: none 1099-B: none 1099-R: none Source documents: Synthetic intake W-2 63d01187-e7e8-427d-931d-a6f8b98cfc5a.pdf=9a596c57-03d6-43bc-8dda-32dc47bf3251; Synthetic W-2.pdf=24989ca4-ca78-4f13-a41b-290669c9b1d7; Corrected 1099-INT.pdf=7e5cabfc-1dc5-4e4c-a787-175bf29b7cf3; Synthetic intake W-2 67ad737a-82ec-4ecf-9dc7-56acf8351dc2.pdf=7820eda6-a6ff-470b-b1d5-9f1d4c2619f9; Synthetic W-2.pdf=ecc85915-fbf4-4466-9759-563cf96fc5f2; Corrected 1099-INT.pdf=f273ad60-154a-43e6-8a88-f9741a41aa83; Synthetic intake W-2 ed7d6e8b-1a1b-4e77-b084-bafb6b11931b.pdf=41f61d4e-fd20-47fd-9590-a504559d8dd1; Synthetic W-2.pdf=a42be397-62a9-493e-8945-8a78ee24972c; Corrected 1099-INT.pdf=543525bc-feee-47fc-8084-cdec37bb2c86; Corrected 1099-INT.pdf=68501945-024c-4d6d-a818-0e2878d39fba; Synthetic intake W-2 5baf6d8d-15f3-43f7-8334-2dc9ed4bc1af.pdf=ce3a33af-b5ea-42db-89d9-20dfa1015d48; Synthetic W-2.pdf=c6e5d743-f0c9-44d8-895c-bf482ef878fa; duplicate.pdf=3d11fb77-2efc-4d69-92ea-2e0947ab95c7; Corrected 1099-INT.pdf=98443567-87a7-4272-a2e3-ba0693fc6ba1; Synthetic intake W-2 e1739212-5dc3-4dce-b934-5668940a91b0.pdf=b9bd23f8-1b50-4856-9b5a-dea177dddfa1 Household-member MAGI ledger Add each household member with a stable id, optional personId, modifiedAgi, tax-family inclusion and review status. Validate & apply details
Alternative marriage-year households For taxpayer and spouse enter pre-marriage family size, modified AGI and federal poverty line. Validate & apply details
Marketplace policies and monthly columns Use one object per policy. Each month requires month, enrollmentPremium, slcspPremium and advancePtc. Percentage values use 100.00 for full allocation. Validate & apply details