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Form 8453-R, Declaration and Signature for Electronic Filing of Forms 8947 and 8963

Use this form to authenticate the electronic filing of:

  • Form 8947, Report of Branded Prescription Drug Information, and
  • Form 8963, Report of Health Insurance Provider Information.

Current Products


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Other Items You May Find Useful:

All Form 8453-R Revisions

Form 8947, Report of Branded Prescription Drug Information

Form 8963, Report of Health Insurance Provider Information

Other Current Products


Comment on Form 8453-R

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Page Last Reviewed or Updated: 12-Mar-2014