Internal Revenue Service United States Department of the Treasury

Instructions for Form 8928 (09/2011)

Return of Certain Excise Taxes Under Chapter 43of the Internal Revenue Code

Section references are to the Internal Revenue Code unless otherwise noted.

Revised: 09/2011


Table of Contents

  • General Instructions
    • Purpose of Form
    • Who Must File
    • When To File
      • Where To File
        • Interest and Penalties
          • Claim for Refund or Credit/Amended Return
        • Specific Instructions
          • Part I. Tax on Failure To Satisfy Continuation Coverage Requirements Under Section 4980B
            • Section A—Failures Due to Reasonable Cause and Not to Willful Neglect
            • Section B—Failures Due to Willful Neglect or Otherwise Not Due to Reasonable Cause
          • Part II. Tax on Failure To Meet Portability, Access, and Renewability Requirements Under Section 4980D
            • Section A—Failures Due to Reasonable Cause and Not to Willful Neglect
            • Section B—Failure Due to Willful Neglect or Otherwise Not Due to Reasonable Cause
          • Part III. Tax on Failure To Make Comparable Archer MSA Contributions Under Section 4980E
            • Part IV. Tax on Failure To Make Comparable HSA Contributions Under Section 4980G
              • Part V. Tax Due
            • Instructions for Form 8928 - Notices
              • Privacy Act and Paperwork Reduction Act Notice.
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