Instructions for Form 8928 (09/2011)

Purpose of Form

File Form 8928 to report the tax due on the following failures by group health plans or employers.

A failure to provide a level of coverage of the costs of pediatric vaccines (as defined in section 2612 of the Public Health Services Act) that is not below the coverage provided as of May 1, 1993.
A failure to satisfy continuation coverage requirements under section 4980B.
A failure to meet portability, access, renewability, and market reform requirements under sections 9801, 9802, 9803, 9811, 9812, 9813, and 9815.
A failure to make comparable Archer MSA contributions under section 4980E.
A failure to make comparable health savings account (HSA) contributions under section 4980G.

Who Must File

Form 8928 must be filed by:

Any employer, group health plan, plan administrator, or plan sponsor liable for the tax under section 4980B for failure to provide the required level of pediatric vaccine coverage or to offer continuation coverage to a qualified beneficiary.
Any employer or group health plan liable for the tax under section 4980D for failure to meet portability, access, renewability, and market reform requirements for group health plans under sections 9801, 9802, 9803, 9811, 9812, 9813, and 9815.
Any employer liable for the tax under section 4980E for failure to make comparable Archer medical savings account (MSA) contributions for all participating employees.
Any employer liable for the tax under section 4980G for failure to make comparable health savings account (HSA) contributions for all participating employees.

When To File

For a failure under section 4980B or section 4980D, if the failure is by an employer or other person responsible for providing or administering benefits under the plan (such as an insurer or third-party administrator), file Form 8928 on or before the due date for filing the person's federal income tax return.

If the failure under sections 4980B or section 4980D is by a multiemployer or multiple employer plan, file Form 8928 on or before the last day of the seventh month following the end of the plan year.

For a failure under section 4980E or section 4980G, file Form 8928 on or before the 15th day of the fourth month following the calendar year in which the noncomparable contributions were made.

Extension. File Form 7004, Application for Automatic Extension of Time to File Certain Business Income Tax, Information, and Other Returns, to request an automatic extension of time to file Form 8928. You must file Form 7004 on or before the regular due date of Form 8928. See the instructions for Form 7004 for more information. Form 7004 does not extend the time to pay excise taxes due under Form 8928.

Where To File

File Form 8928 at the following address.

Department of the Treasury
Internal Revenue Service
Cincinnati, OH 45999-0009

Private delivery services. You can use certain private delivery services designated by the IRS to meet the “timely mailing as timely filing/paying” rule for tax returns and payments. These private delivery services include only the following:

DHL Express (DHL): DHL Same Day Service.
Federal Express (FedEx): FedEx Priority Overnight, FedEx Standard Overnight, FedEx 2Day, FedEx International Priority, and FedEx International First.
United Parcel Service (UPS): UPS Next Day Air, UPS Next Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air A.M., UPS Worldwide Express Plus, and UPS Worldwide Express.

The private delivery service can tell you how to get written proof of the mailing date.

Interest and Penalties

Interest. Interest is charged on taxes not paid by the due date even if an extension of time to file is granted. Interest is also charged on penalties imposed from the due date, including extensions, to the date of payment for failure to file, negligence, fraud, gross valuation overstatements, and substantial understatements of tax. The interest rate is determined under section 6621.

Penalty for late filing of return. If you do not file a return by the due date, including extensions, you may have to pay a penalty of 5% of the unpaid tax for each month or part of a month the return is late, up to a maximum of 25% of the unpaid tax. The minimum penalty for a return that is more than 60 days late is the smaller of the tax due or $100. The penalty will not be imposed if you can show that the failure to file on time was due to reasonable cause. If you file late, you must attach a statement to Form 8928 explaining the reasonable cause.

Penalty for late payment of tax. If you do not pay the tax when due, you may have to pay a penalty of ½ of 1% of the unpaid tax for each month or part of a month the tax is not paid, up to a maximum of 25% of the unpaid tax. The penalty will not be imposed if you can show that the failure to pay on time was due to reasonable cause.

Interest and penalties for late filing and late payment will be billed separately after the return is filed.

Claim for Refund or Credit/Amended Return

File an amended Form 8928 for any of the following:

To claim a refund of overpaid taxes reportable on Form 8928;
To receive a credit for overpaid taxes; or
To report additional taxes due within the same tax year of the filer if those taxes have the same due date as those previously reported.

File an amended return by writing “Amended Return” at the top of Form 8928 and completing the appropriate part.

If you file an amended return to claim a refund or credit, the claim must state in detail the reasons for claiming the refund. In order for the IRS to promptly consider your claim, you must explain why you are filing the claim and provide the appropriate supporting evidence. See Regulations section 301.6402-2 for more details.

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