3.11.29 Health Coverage Tax Credit (HCTC) Enrollment Processing

Manual Transmittal

December 11, 2018

Purpose

(1) This transmits revised IRM 3.11.29, Health Coverage Tax Credit (HCTC) Enrollment Processing.

(2) This IRM is used by employees of Document Perfection’s HCTC Enrollment Team in Entity at the Austin Submission Processing Center. The Enrollment Team evaluates eligibility for the HCTC Advance Monthly Payment program, enters information from Form 13441-A into a database, and authorizes payment of the credit.

Material Changes

(1) Reviewed and updated the IRM where necessary for the following types of editorial changes: updating IRM references; correcting spelling or grammatical errors; updating information that changes annually; adding or correcting IRM references; formatting; and rearranging the flow of the IRM to mimic the processes.

(2) Reviewed and updated the IRM where necessary for the following types of editorial changes: legal citations, published forms, documents, and web addresses.

(3) IRM 3.11.29.1.6 updated instructions for receiving access to restricted accounts.

(4) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.1.7, Acronyms, corrected capitalization

(5) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.4, HCTC Program General Information, added the word "erasable" to paragraph 1 to be more concise and updated paragraph 6.

(6) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.4, HCTC Program General Information, entered NOTE regarding COBRA end date.

(7) IRM 3.11.29.4 added additional editing instructions.

(8) IPU 18U0028 issued 01-02-2018 IRM 3.11.29.4(9), HCTC Program General Information - Added an Exception to help with end of year processing.

(9) IRM 3.11.29.5.4, Replies to Form 14095 - Moved the content to IRM 3.11.29.17 and revised instructions to elevate replies to Planning & Analysis (P&A). Deleted subsection 3.11.29.5.4.

(10) IRM 3.11.29.6, Reporting Time Organization Function Program (OFP) - Updated and moved content to IRM 3.11.29.3. Revised subsection IRM 3.11.29.6 title to Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and added content formerly at IRM 3.11.29.4.

(11) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.6, Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, corrected form number in paragraph (1)(a).

(12) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.7, Batching Form 13441-A, corrected citation in paragraph (3).

(13) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.8, Initial Review of Form 13441-A, added additional details for a health insurance bill and additional instruction for updated forms.

(14) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.8, Initial Review of Form 13441-A, added NOTE regarding documentation.

(15) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.9.1, Inputting Form 13441-A, Part 1: Your General Information, added information to include TIN-V validation statuses.

(16) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.9.1, Inputting Form 13441-A, Part 1: Your General Information, added information regarding priority of receive dates.

(17) IPU 18U0070 issued 01-08-2018 IRM 3.11.29.9.1.1, Determining Eligibility - Added instructions for (7) regarding ITINs and IRSNs and added (8) for when a participant reaches age 65.

(18) IRM 3.11.29.9.1(7) added reference for missing received date.

(19) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.9.2, Inputting Form 13441-A, Part 2: Confirm Your Eligibility, added information to match form update.

(20) IRM 3.11.29.9.2, Inputting Form 13441-A, Part 2: Confirm Your Eligibility, updated figure to match updated form and added additional instructions..

(21) IRM 3.11.29.9.3, Inputting Form 13441-A, Part 3: Family Member Information, updated figure to match updated form.

(22) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.9.3, Inputting Form 13441-A, Part 3: Family Member Information, updated paragraph 7 to match new form updates.

(23) IPU 18U0028 issued 01-02-2018 IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information - Updated content in (8) regarding COBRA insurance and added (9) regarding procedures for Lifetime Benefits.

(24) IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information, updated figure to match updated form and clarified entry of COBRA information.

(25) IPU 18U0070 issued 01-08-2018 IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information - Added note to (9)b regarding existing COBRA end date.

(26) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information, updated database prompt names and requirements.

(27) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.9.4, Inputting Form 13441-A, Part 4: Health Plan Information, added chart (2) for entering policy holder information, updated line numbers to coordinate with form changes, added information about COBRA start and end dates (10).

(28) IRM 3.11.29.9.5(2) added note about communication with the participant.

(29) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.10, Setting the Status of the Application, added a chart for determining the status of an application.

(30) IRM 3.11.29.11 added additional systemically generated status types.

(31) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13, Correspondence, added information regarding new Letter 6011.

(32) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.13.1, Letter 3772, End of Program Letter, removed additional punctuation.

(33) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13.1, Letter 3772, End of Program Letter, updated information regarding status of the application.

(34) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility, updated information regarding status of the application.

(35) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13.5, Letter 4541, HCTC Candidate Insufficient Documentation - System Letter, updated information regarding status of the application.

(36) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13.6, Letter 4545, HCTC Enrollment Letter, updated information regarding status of the application.

(37) IPU 18U0028 issued 01-02-2018 IRM 3.11.29.13.9, Letter 5974, Annual HCTC Vendor Renewal Notification - Removed requirement to enclose a blank Form 3881-A with correspondence.

(38) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.13.11, Letter 6011, Return of HCTC Funds, added new section for new letter.

(39) IPU 18U0133 issued 01-17-2018 IRM 3.11.29.14, Form 4442, Inquiry Referral, added instruction elevate Form 1099-H to P&A analyst.

(40) IPU 18U0997 issued 06-26-2018 IRM 3.11.29.14, Form 4442, Inquiry Referral, added that correspondence and faxes received directly from participants and administrators should be processed by the enrollment team following Form 4442 instructions.

(41) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.15, Qualified Family Member Participant (QFMP) Under Certain Provisions, added information regarding previously enrolled QFM.

(42) IRM 3.11.29.15(9) added information about eligibility of Qualifying Family Member Participants.

(43) IPU 18U0028 issued 01-02-2018 IRM 3.11.29.18(2), SF-1034, Public Voucher for Purchases and Services other than Personal, Monthly Payment Reconciliation - changed "reimbursed" to "refunded" .

(44) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.20.1, Submitting and Updating Forms 3881-A, corrected spelling.

(45) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.20.2, Recertifying with Form 3881-A, corrected spelling.

(46) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.21, Payment Submission / Lockbox / Daily Mail-Out Package, corrected spelling.

(47) IPU 18U1177 issued 08-20-2018 IRM 3.11.29.22, Insufficient Funds Notification, corrected spelling.

Effect on Other Documents

IRM 3.11.29, dated January 1, 2018, is superseded.

Audience

Employees in the Austin Submission Processing Center and Customer Service Representatives in Accounts Management.

Effective Date

(12-11-2018)


Linda J. Brown
Director, Submission Processing
Wage and Investment Division

Program Scope and Objectives

  1. Purpose: This IRM provides guidance on the Health Coverage Tax Credit (HCTC).The Enrollment Team evaluates eligibility for the monthly advance payment, enters information from Form 13441-A into a database, authorizes payment of the credit, and sets up approved HCTC vendors for ACH payments.

  2. Audience: The HCTC Enrollment Team, in Austin, is the primary user of this IRM.

  3. Policy Owner: The Director of Submission Processing

  4. Program Owner: Wage and Investment (W&I) Submission Processing

  5. Primary Stakeholders: The HCTC Enrollment Team in Austin

  6. Program Goals: The information contained in this IRM provides the HCTC Enrollment Team instructions to evaluate eligibility for the advance monthly payments of the HCTC.

Background

  1. The Health Coverage Tax Credit (HCTC), authorized in the Trade Adjustment Assistance Reform Act of 2002, first became effective for coverage months beginning after August 6, 2002. The HCTC later expired for coverage months after 2013. But, the Trade Adjustment Assistance Reauthorization Act of 2015 restored the HCTC retroactively for 2014 coverage, erasing the hiatus in its duration, and extended it for coverage through the end of 2019, when it expires again.

  2. The HCTC subsidizes most of the cost of qualified health insurance for eligible individuals and their eligible family members. The credit pays 72.5% of the insurance premiums while the participant enrolled in the program pays 27.5% of the premiums.

  3. Eligibility for the HCTC is restricted to two groups of individuals:

    1. Individuals who are eligible for benefits under the program Trade Adjustment Assistance (TAA) because of a qualifying job loss and receive benefits through the Trade Readjustment Allowance (TRA), Reemployment Trade Adjustment Assistance (RTAA), or Alternative Trade Adjustment Assistance (ATAA)

    2. Individuals who are between 55 and 64 years old, whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC), and are not enrolled in Medicare

  4. Individuals eligible for the HCTC are allowed the tax credit only if they aren’t enrolled in certain government- or employer-subsidized health coverage (Medicaid, for instance) and aren’t eligible for other specified coverage (Medicare Part A or TRICARE).

  5. To apply for the HCTC, applicants submit Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and the required supporting documents to IRS, Mail Stop 6098 AUSC, Austin, TX 78741.

Authority

  1. Authority for these procedures is found in Internal Revenue Code (IRC) Section 7527.

  2. All Policy Statements for Submission Processing are contained in IRM 1.2.12, Servicewide Policies and Authorities, Policy Statements for Submission Processing Activities.

Roles and Responsibilities

  1. The Director of Submission Processing is the executive responsible for overseeing policy and guidance for employees of the Austin Submission Processing Center and ensuring consistent application of policies and procedures to effect tax administration while protecting taxpayers’ rights.

  2. The Submission Processing Field Director, reports to the Director Submission Processing, and is responsible for the delivery of policy and guidance that impacts the HCTC Advance Monthly Payment process.

  3. The Operation Manager is responsible for implementing policy and guidance that impacts the HCTC Advance Monthly Payment process.

  4. All employees must perform their professional responsibilities in a way that supports the IRS Mission in order to provide top quality service and to apply the law with integrity and fairness to all.

Program Reviews

  1. The HCTC program is an unmeasured program for production. However, due to the nature of the program, all applications, changes, reimbursement requests, and correspondence are 100% quality reviewed.

Program Controls

  1. IRS will implement access control measures that will provide protection from unauthorized alteration, loss, unavailability, or disclosure of information. Access controls will follow the principle of access enforcement, least privilege, separation of duties, system-use notifications, session locks, and session lock-control enhancements as defined in IRM 10.8.1, Information Technology (IT) Security, Policy and Guidance.

IDRS Notice Issuance

  1. While working assigned cases, Submission Processing employees may come across some accounts that are blocked on IDRS and can be identified by an IDRS security violation message, "Unauthorized Access to this Account" . Forward the case to your manager. Managers will notify the local Planning & Analysis Staff who will scan the case and send encrypted information to the ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ mailboxto request access to the account. Managers will retain the case in a file awaiting access (can take up to 5 business days). Once notified access has been granted, the documents can be worked following applicable procedures.

Acronyms

  1. Following are commonly used acronyms:

    Acronym Meaning
    ATAA Alternative Trade Adjustment Assistance
    COBRA Consolidated Omnibus Budget Reconciliation Act
    DoL Department of Labor
    DPO Document Perfection Operation
    DSRA-BT Delphi Salaried Retirees Association Benefit Trust
    HCTC Health Coverage Tax Credit
    HPA Health Plan Administrator
    IDRS Integrated Data Retrieval System
    P&A Planning and Analysis
    PBGC Pension Benefit Guaranty Corporation
    PIN Participant Identification Number
    QFMP Qualified Family Member Participant
    RCO Receipt Control Operation
    RTAA Reemployment Trade Adjustment Assistance
    SWA State Workforce Agency
    TAA Trade Adjustment Assistance
    TPA Third Party Administrator
    TRA Trade Readjustment Allowance

Deviations from the IRM

  1. Service Center Directors, Headquarter Branch Chiefs, and Headquarter Analysts do not have the authority to approve deviations from IRM procedures. Any request for an exception or deviation to an IRM procedure must be elevated through appropriate channels for executive approval. This will ensure that other functional areas are not adversely affected by the changes and that it does not result in disparate treatment of taxpayers.

  2. See guidelines in IRM 1.11.2, Internal Revenue Manual (IRM) Process. Request for an IRM deviation must be submitted in writing and signed by the Field Director, following instructions from IRM 1.11.2.2.4. Any disclosure issues will be coordinated by the Program Owner. No deviations can begin until they are reviewed by the Program Owner and approved at the Executive Level. All requests must be submitted to the Submission Processing Headquarters IRM Coordinator.

Reporting Time - Organization Function Program (OFP)

  1. Report all time spent in processing or handling HCTC forms with the organization, program, and function codes (OFP) below.

    Function/Program WP&C Title Application Type
    390-84310 F14095 Original Form 14095
    390-84311 14095COR F14095 correspondence
    390-84312 14095RPL F14095 reply to correspondence
    390-84313 14095NOR F14095 without a reply to correspondence
    390-84330 HCTC New Form 13441-A applications
    390-84331 HCTCUPDT Updated F13441-A applications
    390-84332 HCTC4442 Inquiries with Form 4442 or from US Bank
    390-84333 HCTCCORR Forms with correspondence (suspense)
    390-84334 HCTCRPLY Forms with a reply to correspondence
    390-84335 HCTCNORP Forms without a reply to correspondence
    770-84310 F14095 Clerical - Form 14095
    770-84330 HCTC Clerical - Form 13441-A

HCTC Program General Information

  1. All forms, correspondence, and documentation needing editing should be edited in erasable red ink.

    Note:

    Remove all editing marks prior to returning any document to an applicant.

  2. All forms, correspondence, and documentation should be stamped with Tax Examiner’s stamp each time they must be corrected.

  3. All forms, correspondence, and documentation should contain a Received Date stamp. If the date is missing, notate the date as "Rcvd MMDDYY" and use the dates in the following order to determine the Received Date:

    • Latest postmark on the envelope (Post Office mark), the latest date on from a designated private delivery service (PDS) mark or electronic transmission date (date of fax or email)

    • Service Center Automated Processing System (SCAMPS) digital date

    • Participant’s latest signature date

    • Today’s date

  4. All forms, correspondence, and documentation should be stapled to the back of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, in Received Date order with the oldest (Original) Form 13441-A stapled to the top. If an updated Form 13441-A is submitted, then any prior Form 13441-A should be "X’d."

  5. If any information on HCTC forms is "X’d," crossed out, or lined through, either pre-printed or manually, it should be considered invalid.

  6. Missing, invalid, or illegible entries on HCTC forms, may be perfected with relevant information found in supporting documentation. If "required" information cannot be perfected with other information provided by the applicant, see IRM 3.11.29.13 for Correspondence.

  7. If you must delete a record from the database, refer the application to the HCTC Coordinator or Entity Team Work Leader.

  8. Never obliterate, alter or erase the original entry on a return when deleting or correcting an entry. Make sure the original entry remains legible.

  9. The interim database did not carry over several key fields to the current HCTC database. Therefore, it is important when entering updates for a participant from the interim HCTC program to update any missing or omitted fields in the database with relevant information from the new update or supporting documentation. The HCTC interim program ran from July – December 2016 in which participant PIN numbers have a 6 as the beginning digit after 0.

  10. When entering updates for a participant, update any missing or omitted fields in the database with relevant information from the new update or supporting documentation.

    Exception:

    This rule does not apply when updating end-of-year rate change attestation spreadsheets. The attestation spreadsheets allow for rate changes only. The participant's file is not required to be present. However, the 4442s will need to be added to each participant's file in a timely manner but no later than one week following the update.

    Note:

    If there is a COBRA end date when updating a change in insurance vendor, refer to HCTC Coordinator.

  11. Always edit an Action Trail on the application when any documentation is removed. For example, when a form or letter is detached from an application, edit notations such as "Detached Family Member’s page 3 PIN 10000XXXXX."

  12. Edit an Action Trail on any detached document unless it's an original document. If present on the application, all the following must be present or edited on all detached items:

    • Current date, otherwise use the received date in "MMDDYY" format

    • Form from which detached

    • Participant’s name

    • Participant’s Identification Number (PIN)

  13. Comments must be entered into the HCTC database for any correspondence, inquiry, or action to participants account. Comments must be specific and include the nature of the amendment.

  14. Anytime a record is modified in the database see IRM 3.11.29.12, Setting the Status of the Application.

  15. When a record is modified all entries in the database must be supported by documentation in the applicant’s file.

  16. Forms and correspondence received by the HCTC Enrollment Team are to be processed or routed within 5 business days from the date received by the Enrollment Team.

Access to the HCTC Database

  1. For Tax Examiners to process, edit, and review HCTC forms, they must request access to the HCTC Database through the Online 5081 system.

  2. Roles are granted based on job duties as follows:

    Role OL5081 Application Name and Group
    Clerk PROD USER HCTC CLERK DR USER HCTC CLERK
    Examiner PROD USER HCTC TAX EXAMINER
    Reviewer PROD USER HCTC QUALITY REVIEWER DR USER HCTC QUALITY REVIEWER
    Customer Service PROD USER HCTC READ ONLY DR USER HCTC READ ONLY
    Admin PROD USER HCTC ADMIN (HEALTH COVERAGE TAX CREDIT-HCTC)
    Reports PROD USER HCTC REPORTS (HEALTH COVERAGE TAX CREDIT-HCTC)
  3. A warning that the database is for authorized use only appears when accessing the database. Users must accept the terms of use to open the database.

Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update

  1. Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, is processed in two operations in Austin Submission Processing: Receipt & Control (RCO) and Document Perfection (DPO).

    1. In RCO, clerks receive, extract, and Receive Date stamp Form 13441-A. RCO then routes Form 13441-A to DPO’s Entity Enrollment Team at AUSC Stop 6098 at the Austin Service Center.

    2. In DPO, clerks in the Entity Enrollment Team batch Form 13441-A. Tax Examiners screen enrollment Forms 13441-A for completeness and to determine any need for correspondence. They will accept or correspond for the correction of defects.

Batching Form 13441-A

  1. Batching Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, occurs in the Entity Enrollment Team.

  2. Separate new Forms 13441-A from updated Forms 13441-A. Batch new and old separately.

    Note:

    Applicants who update their registration may check box 6 on page 1 of Form 13441-A.

  3. Follow instructions in IRM 3.10.5.6.1, Batch Creation Screen, for creating batches in the BBTS system.

  4. Batch Forms 13441-A by the IRS received date in groups of 25. Each form in the batch must have the same received date.

  5. Print batch transmittals and associate the transmittals with their batches.

  6. Stage batches by Received Date in the designated work area.

Initial Review of Form 13441-A

  1. Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, is made up of six parts.

    • Part 1, Your General Information

    • Part 2, Confirm Your Eligibility

    • Part 3, Family Member Information

    • Part 4, Health Plan Information

    • Part 5, Account Accessibility

    • Part 6, Form Completion

  2. Verify the applicant signed the form in Part 6. See IRM 3.11.29.9.6, Inputting Form 13441-A Part 6: Form Completion.

  3. Edit a Received Date on the first page of Form 13441-A, if missing.

  4. Stamp your Tax Examiner number in the upper left of the first page of Form 13441-A.

  5. Verify Form 13441-A is batched correctly. If the form is in the wrong batch, remove the form and have the clerk re-batch.

  6. Applicants must submit a copy of a health insurance bill dated within the last sixty days with Form 13441-A.

    1. The bill must provide the following information. If any of the items in the following list are missing, see IRM 3.11.29.13, Correspondence.
      - Name of applicant
      - Dates of coverage
      - Amount of monthly premium
      - Name of Health Plan Administrator (HPA)

    2. Applicants who have changed their insurance or acquired insurance within the last sixty days won’t have a bill or may not have to provide one. They may submit a statement or letter verifying coverage from their Health Plan Administrator (HPA) with the above criteria in lieu of a bill.

    3. Participants may submit multiple pieces of documentation in order to meet the requirements.

      Note:

      Forms submitted by the participant to their administrator in order to elect coverage are not acceptable in lieu of a bill.

  7. Forms 13441-A being updated by the participant may have only the fields being updated completed. If any required fields are missing, edit the missing information from the latest Form 13441-A and/ or the documentation attached to the file.

    Exception:

    Updated Forms 13441-A require a signature in order to be processed. If the updated form indicates a change in who the credit is being claimed for or in the health plan, the certification boxes in Part 2 must be checked.

  8. If a remittance discovered in an application packet or in correspondence connected to or mentioning the HCTC, do the following:

    If ... Then ...
    a) The remittance is payable to the US Treasury - HCTC Send correspondence, remittance, and a copy of Form 13441-A, if available to:
    US Treasury - HCTC
    PO Box 970023
    St. Louis, MO 63197-0023
    b) The remittance is payable to IRS, the Federal Reserve, or a HPA/TPA vendor Determine the intent of the payment from the documents in the application packet or correspondence. Send any remittance intended for the HCTC, along with correspondence, and a copy of Form 13441-A, if available to:
    US Treasury - HCTC
    PO Box 970023
    St. Louis, MO 63197 - 0023
    c) It is determined that remittance is not for HCTC Follow IRM 3.8.46.1 procedures for Discovered Remittances

Inputting Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, Into the Database

  1. Before entering Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the database, search for an existing application from the participant already in the database.

    1. If the applicant is not in the database, create a new record with the information from Form 13441-A.

    2. If the applicant is already in the database:

      And... Then...
      1) The documents are a response to correspondence and the status of the applications is "Waiting for supporting documentation"
      • Enter the requested items into the database

      • Change any information in the database the applicant changed in the response

      2) The documents are a response to correspondence and the status of the application is "Ineligible" Refer to HCTC Coordinator
      3) The document is not a response to correspondence and doesn’t change the information in the database Consider the Form 13441-A a duplicate and associate it with the original Form 13441-A
      4) The document is not a response to correspondence; however, it changes information in the database and the status of the application isn’t "Declined," "Ineligible," or "Enrolled"
      • Revise the affected information in the database and modify the applicant’s status, if needed

      • Associate the response with the original application

      • Consider the submission a superseding or supplementary Form 13441-A

Inputting Form 13441-A, Part 1: Your General Information

  1. Enter the information from Part 1: Your General Information of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant fields of the database.

    Figure 3.11.29-1

    This is an Image: 69551400.gif
     

    Please click here for the text description of the image.

  2. The fields for the HCTC Database, Part 1, General Information, are as follows:

    Field Items Format Length Required
    IRS Received Date Stamp Numeric 8 Yes
    First Name Alphanumeric 25 Yes
    Middle Name Alpha 25 No
    Last Name Alphanumeric 35 Yes
    Suffix Alphanumeric 10 No
    Social Security Number Numeric 9 Yes
    Date of Birth Numeric 8 Yes
    Primary Phone Number Numeric 10 No
    Alternative Phone Number Numeric 10 No
    Mailing Address Line 1 Alphanumeric 55 Yes
    Mailing Address Line 2 Alphanumeric 55 No
    City Alpha 30 Yes
    State Alpha 2 Yes
    Zip Code Numeric 15 No

    Note:

    Don’t abbreviate names. If a name is longer than the field, type it as written until you reach the end of the field.

  3. If the SSN on Form 13441-A is invalid and cannot be located, research IDRS Command Code (CC) INOLES. If still unable to confirm then elevate to P&A.

  4. If any required information (except the SSN), as noted in (2) above, is missing, invalid, or illegible continue creating the record in the database. After the record is created, if the required information can’t be perfected with other information provided by the applicant or with research in IDRS, see IRM 3.11.29.13, Correspondence. Edit, in erasable, red ink on Form 13441-A any required information perfected.

  5. If any non-required information, as noted in (2) above, is missing, and is discovered in the review of Form 13441-A, enter it into the database. Editing perfected non-required information on Form 13441-A is optional. Use IDRS CC NAMES to perfect the address.

    Note:

    Use the envelope and attachments to perfect a defective address. Don’t replace the address on the Form 13441-A with the address from the envelope or in any attachment. Use the address from the envelope or in an attachment only to perfect elements of the address such as the house number, street name, apartment number, or zip code.

  6. If both a PO Box and a street address appear on the form, enter the street address in the Mailing Address Line 1 field of the database and the PO Box in the Mailing Address Line 2 field of the database.

  7. Enter the original IRS Received Date. If an update is received, the original received date should be honored. If the received date is missing, see IRM 3.11.29.4 , HCTC Program General Information.

  8. Determine the received date according to the list below when the date is necessary but not stamped or written on the return.

    1. Latest postmark on the envelope (post office mark) or the latest date from a designated private delivery service (PDS) mark.

      Note:

      When the envelope or label is not attached, use the postmark date stamped or handwritten on the return to determine the received date.

    2. Service Center Automated Mail Processing System (SCAMPS) digital dates.

    3. Latest date by the participant’s signature(s).

  9. After you enter the applicant’s Social Security Number (SSN) into the database, an eligibility indicator appears. See IRM 3.11.29.9.1.1, Determining Eligibility.

  10. After the SSN is entered in to the database, the database will use the TIN-V process to validate and auto-fill fields based on the SSN. It is not necessary to correct auto-filled entries in the database. If the SSN fails TIN-V, the status will change to either" Ineligible: Could Not Validate TIN at This Time" or "Cancelled - Ineligible: TIN Validation Failure," and the application must be elevated to P&A. When elevating to P&A, please include the complete file and an IDRS screen shot of the INOLES screen.

Determining Eligibility
  1. Eligibility for the HCTC is restricted to two groups of individuals.

    1. Individuals who are eligible for benefits under the program Trade Adjustment Assistance (TAA) because of a qualifying job loss and receive benefits through the Trade Readjustment Allowance (TRA), Reemployment Trade Adjustment Assistance (RTAA), or Alternative Trade Adjustment Assistance (ATAA).
      - TRA is a weekly cash payment for workers no longer eligible for unemployment benefits
      - RTAA is a wage supplement for workers who are 50 or older and certified eligible under the terms of the TAA and find employment at a lower wage
      - ATAA is a wage insurance like RTAA

    2. Individuals who are between 55 and 64 years old, whose defined benefit pension plans were taken over by the Pension Benefit Guaranty Corporation (PBGC), and are not enrolled in Medicare.

  2. An individual is eligible for the HCTC on the first day of a month if the individual received a TAA benefit for any day in that month or the month before.

  3. Only individuals who receive cash benefits through the TRA, RTAA, or ATAA may be certified eligible for benefits under TAA. Individuals who receive non-cash benefits, such as assistance with looking for a job, aren’t eligible for the HCTC.

  4. To determine the applicant’s eligibility for the HCTC, the database checks the record created from Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, against information from the Department of Labor (DoL) and PBGC. The Enrollment Team receives eligibility files from the DoL daily and the PBGC monthly.

  5. Enter the applicant’s SSN into the database. If the eligibility indicator "Individual is Eligible (Code 00)" appears, proceed with creating the record.

  6. If after entering the applicant’s SSN into the database, the eligibility indicator does not appear:

    1. Verify the SSN with CC INOLES in IDRS.
      - If the SSN on Form 13441-A doesn’t belong to the applicant, search IDRS for the valid SSN with CC NAMES or within the supporting documentation.
      - If the applicant entered the wrong SSN on Form 13441-A, replace the incorrect SSN in the database with the valid SSN retrieved from CC NAMES or from the supporting documents. Write the correct SSN in the margin to the left of the box for the SSN.
      - Proceed with creating the record in the database.

    2. Verify a letter of eligibility from the DoL, PBGC, or relevant Form 1099-R, Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc., is present. See Exhibit 3.11.29-1, Exhibit 3.11.29-2, Exhibit 3.11.29-3, Exhibit 3.11.29-4.
      - If present, consider the applicant eligible and proceed with processing Form 13441-A.
      - If not present, see IRM 3.11.29.13, Correspondence.

  7. An applicant with an IRSN or ITIN is ineligible for the HCTC. If the applicant’s TIN is an ITIN or IRSN:

    1. Do not enter the Form 13441-A into the database.

    2. Send correspondence Letter 4540 to the participant. See IRM 3.11.29.13.4, Correspondence, Letter 4540.

    3. Choose Paragraph 8 – Unqualified health insurance coverage.

    4. Return Form 13441-A and all supporting documentation to the applicant.

  8. An applicant is not eligible after becoming eligible for Medicare at age 65. Correspond using letter 4540 and include the following open paragraph: "You or a family member is eligible to enroll in Medicare." See IRM 3.11.29.13.4, Correspondence, Letter 4540.

Inputting Form 13441-A, Part 2: Confirm Your Eligibility

  1. Enter the information from Part 2: Confirm Your Eligibility of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant fields of the database.

    Figure 3.11.29-2

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    Please click here for the text description of the image.

  2. There are sections to confirm participant eligibility:

    1. Confirming the participant is eligible through either PBGC ot TAA

    2. Confirming the participant meets general requirements

    3. Confirming if the participant is a Qualifying Family Member Participant. See IRM 3.11.29.15, Qualifying Family Member Participant (QMFP) Under Certain Provisions.

  3. For statement one, Check the box that applies to you to certify that the statement is true, if neither or both boxes are checked:

    And Then
    1. Either are present:
    • An official letter from the Pension Benefit Guaranty Corporation (PBGC) stating that the applicant received a benefit

    • Form 1099-R showing a benefit paid by the PBGC

    Select the PBGC button on the screen
    2. Either are present:
    • An official letter from the Department of Labor (DoL) states that the applicant is eligible for the trade adjustment benefits

    • A letter from a state workforce agency (SWA) or employment office states that the applicant is eligible for trade adjustments benefit

    Select the TAA, ATAA, or RTAA button on the screen
    3. You cannot determine which group the applicant belongs to See IRM 3.11.29.13, Correspondence
  4. For statement two "I certify that all of the following statements are true for me and my qualified family member" , if the box is not checked see IRM 3.11.29.13, Correspondence.

  5. Select the third box when the participant is eligible as a QFMP. If the applicant is a QFMP, a start date for the QFM must be entered. See IRM 3.11.29.15, Qualified Family Member Participant Under Certain Provisions. The database will calculate an end date of 24 months after the start date.

    Note:

    The database was updated on October 16, 2018, to include the QFMP fields. When updating records entered in the database prior to the update, the QFMP fields can be perfected, but it is not required. Correspondence should not be issued to perfect these fields.

Inputting Form 13441-A, Part 3: Family Member Information

  1. In Part 3: Family Member Information of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant reports family members (other than themselves) registering for the HCTC. For a Qualified Family Member see IRM 3.11.29.15.

    Figure 3.11.29-3

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    Please click here for the text description of the image.

  2. If there is no family member information in Part 3, select "No" on the Family Member Information screen of the database for "Does the applicant have qualified dependents?"

  3. If family member’s information appears in Part 3, select "Yes" on the Family Member Information screen of the database for "Does the applicant have qualified dependents?"

  4. Enter available information from Part 3: Family Member Information of Form 13441-A, into the relevant fields of the HCTC database. The database prompts are as follows:

    Family Member Item Required
    a. First Name Yes
    b. Middle Initial No
    c. Last Name Yes
    d. Suffix No
    e. Family member’s relationship to applicant No
    f. Social Security Number

    Note:

    If TIN displays as invalid, then verify the validity of the family member’s SSN with IDRS CC INOLES. ATINs and ITINs do not affect HCTC family member’s eligibility and are acceptable.

    Yes
    g. Date of Birth No
    h. Is this person on the applicant’s health plan? Yes
  5. If any required information, as noted in the table above is missing, invalid, or illegible, correct information with relevant information found in supporting documentation. If the required information can’t be perfected with other information provided by the applicant see IRM 3.11.29.13, Correspondence.

  6. If the applicant’s responds "No" to "Is this person on the applicant’s health plan?" a separate Part 4 with family member’s Health Plan Information must be provided.

    1. If ... Then ...
      A separate Part 4 is provided
      1. Detach family member’s Page 3 (Part 4) from the original application. The family member needs to submit a separate Part 4 only. They do not need to submit a separate Form 13441-A.

      2. Enter information as a separate record to establish a new PIN for the family member who has a separate health plan.

      3. Edit new family member’s PIN, above Part 4: Health Plan Information, in right corner and process the application.

      4. Edit action trail per IRM 3.11.29.4, HCTC Program General Information.

      A separate Part 4 is not provided Correspond with Letter 4545. See IRM 3.11.29.13.6, HCTC Enrollment Letter.
  7. If the applicant indicates more than five family members, an additional copy of Form 13441-A, Part 3 must be attached. If not attached, see IRM 3.11.29.13, Correspondence.

Inputting Form 13441-A, Part 4: Health Plan Information

  1. In Part 4: Health Plan Information, the applicant reports information about the health plan provider. Enter available information from Part 4 of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, into the relevant fields of the HCTC database.

    Figure 3.11.29-4

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    Please click here for the text description of the image.

  2. Each policy holder for each Part 4 must have their own record. See IRM 3.11.29.9.3(6).

    If And Then
    The eligible recipient is the policy holder   Enter the record under the eligible recipient
    The eligible recipient is not the policy holder They are covered on the policy Enter the record under the policy holder’s name indicated in Part 4 and enter the eligible recipient as a family member in the database
    The eligible recipient is not the policy holder They are not covered on the policy Enter the record under the policy holder’s name indicated in Part 4
  3. The database prompts are below. Applicants must provide any item marked required. If any required information is missing, see IRM 3.11.29.13, Correspondence.

    Health Plan Item Required
    a. Vendor Name Yes
    b. Vendor Number Auto populated
    c. Effective Date of Coverage (MMDDYYYY) Yes
    d. Health Plan ID Number No
    e. Member ID* See Note
    f. Group ID* See Note
    g. Policy or Plan ID* See Note
    h. Policy Holder’s First Name Yes
    i. Policy Holder’s Middle Initial No
    j. Policy Holder’s Last Name Yes
    k. Policy Holder’s Suffix No
    l. Social Security Number Yes
    m. Total Monthly Premium (line 1) Yes
    n. Total number of people on policy (line 2) No
    o. Number of family members on policy who are not qualified for the HCTC (line 3) No
    p. Monthly premium amount for family members not qualified for the HCTC (line 4) See second Note below
    q. Other Health Benefits Amount (line 6) No
    r. Total HCTC (line 5) Auto populated
    s. Monthly HCTC Payment (line 7) Auto populated
    t. Total Government Payment Auto populated

    Note:

    At least one of Member ID, Group ID, or Policy ID is required.

    Note:

    This field is required if a family member has a separate policy.

  4. The HPA Vendor Number, Member ID, Group ID, and Policy or Plan ID will be reviewed by the HCTC Coordinator or Entity Team Work Leader prior to input.

    1. The HCTC Coordinator or Entity Team Work Leader will attach a Vendor Verification Form to the bottom right of Part 4. Where present, the entries on Vendor Verification Form will take precedence over the entries on Form 13441-A.

    2. If the HCTC Coordinator or Entity Team Work Leader is unable to determine the HPA Vendor Number, Member ID, Group ID, or Policy or Plan ID through review of the file, elevate to P&A.

    3. If any updates are received, review the HPA Vendor Number, Member ID, Group ID, and Policy or Plan ID to determine if the participant is requesting a change. If the participant is requesting a change, elevate to the HCTC Coordinator or Entity Team Work Leader.

    Note:

    Vendors must annually recertify as an approved HCTC vendor. See IRM 3.11.29.20.2, Recertifying with Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment - HCTC.

  5. For "Total number of people on policy," see the following table.

    If ... Then ...
    a. The "Total number of people" on line 1 of the form is blank and no family members appear in Part 3 Enter 1 on line "Total number of people on policy" in the database
    b. A number greater than 1 for "Total number of people" appears on line 1 of the form and no family members appear in Part 3 See IRM 3.11.29.13, Correspondence
    c. The "Total number of people" on line 1 of the form is blank and family members appear in Part 3 Enter the sum of the applicant plus the family members from Part 3 of the form on "Total number of people" in the database
  6. For the database prompt, "Number of family members on policy who are not qualified for the HCTC," if the "Number of family members" on line 3 of the form is greater than zero and line 4, "Monthly Premium" is blank or zero, then enter the number from line 3 from Form 13441-A on to "Number of family members on policy who are not qualified for the HCTC" in the database.

  7. If line 4 on the form, "Monthly premium amount for family members not qualified for the HCTC" is greater than zero and line 3 of the form, "Number of family members..." is blank or zero, then edit the form to move the amount on line 4 to line 6 of the form and enter the amount into the database for "Other Benefits Amount." See IRM 3.11.29.4, HCTC Program General Information for editing instructions.

    Note:

    The database calculates the lines of "Monthly premium amount for family members not qualified for the HCTC" and "Other Benefits Amount" differently. It is important to enter any amount from Form 13441-A, line 4, on to the "Other Benefits Amount" of the database.

  8. For "Other Benefits Amount," enter the amount from the Form 13441-A, line 6, on to "Other Benefits Amount" of the database. This amount includes premium amounts for additional insurance besides health, such as vision and dental. If there is amount on line 4 and line 6 of Form 13441-A, add the amounts together and input the total on to "Other Benefits Amount" of the database.

  9. Only enter Consolidated Omnibus Budget Reconciliation Act (COBRA) information from Part 4: Health Plan Information of Form 13441-A, into the relevant fields of the HCTC database if TAA was selected when entering the information from Part 2: Confirm Your Eligibility of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update.
    The database prompts are as follows:

    COBRA Information Required
    a. Former Employer No
    b. Former Employer’s HR Phone Number No
    c. Start Date for COBRA Coverage (mm/dd/yyyy) No
    d. End Date for COBRA Coverage (mm/dd/yyyy) No
    e. Lifetime Benefit checkbox No


    If the Check here only if the Health Plan Information in Part 4 is for COBRA Coverage checkbox is selected:

    If Then
    COBRA Start and End dates are present Enter dates into the database
    COBRA Start and End dates are not present Refer to the HCTC Coordinator
  10. If the Lifetime Benefit checkbox is selected:

    1. Make sure the TAA box in Part 2: Confirm Your Eligibility of Form 13441-A is checked

    2. Make sure there is no COBRA end date for coverage

      Note:

      If there is an existing COBRA end date in the database, then overlay it with the date of 12/31/2019.

    3. Change the participant’s birth year to 2000 in the database and add the actual birth year in a comment stating "Lifetime Benefits: Actual birth year 19xx"

      Note:

      If the birth year is not changed to 2000 for those receiving Lifetime Benefits, when the database completes its daily update, it will automatically un-enroll participants over 65 years old.

  11. If any required information, as noted in the tables above is missing, invalid, or illegible, correct information with relevant information found in supporting documentation. If the required information can’t be perfected with other information provided by the applicant, follow the instructions in the table below.

    If ... Then ...
    a. All research has been exhausted and it is determined that the vendor is not enrolled See IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility, and use paragraph 13
    b. The policy holder is the applicant and the policy holder’s SSN differs from the SSN in Part 1 of Form 13441-A Replace the SSN in Part 4 with the valid SSN from Part 1 of Form 13441-A

Inputting Form 13441-A, Part 5: Account Accessibility

  1. In Part 5: Account Accessibility of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant can designate a Third-Party to have access to their account information.

    Figure 3.11.29-5

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    Please click here for the text description of the image.

  2. Only enter information from Part 5: Account Accessibility of Form 13441-A, if a five digit numerical Personal Identification Number (PIN) is provided.

    Note:

    Do not enter any information if the applicant has indicated "No" to the question "Do you want to allow another person to talk with the HCTC Program about your account?"

  3. No correspondence is necessary if any of the information is missing or incomplete.

Inputting Form 13441-A, Part 6: Form Completion

  1. In Part 6 of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, the applicant signs the form. Do not process Form 13441-A without a signature. See IRM 3.11.29.13.5, Correspondence, Letter 4541, HCTC Candidate Insufficient Documentation – System Letter.

    Figure 3.11.29-6

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    Please click here for the text description of the image.

  2. The signature must appear under the jurat — "Under penalty of perjury…" —and above the phrase "Privacy Act and Paperwork Reduction Act Notice." Form 13441-A is unacceptable if it is signed outside this area. Consider such a Form 13441-A unsigned and see IRM 3.11.29.13.5, Correspondence, Letter 4541, HCTC Candidate Insufficient Documentation – System Letter.

  3. Faxed, digital, or photocopied signatures are acceptable.

  4. Accept a signature by a third party to whom the applicant has granted power of attorney (PoA).

    1. Form 2848, Power of Attorney and Declaration of Representative, names the third party and may be present in the packet.

    2. If Form 2848 is not part of the packet, look for the PoA with IDRS CC CFINQ.

    3. If the applicant hasn’t granted power of attorney to the person who signed the Form 13441-A, consider Form 13441-A unsigned and see IRM 3.11.29.13.5, Correspondence, Letter 4541, HCTC Candidate Insufficient Documentation – System Letter.

  5. If the signature section is "X’d," crossed out, or lined through, either pre-printed or manually, see IRM 3.11.29.4(5), HCTC Program General Information.

  6. If you enter Form 13441-A with a missing signature in error into the database:

    1. Set the eligibility status to "Processing— Waiting for Supporting Docs."

    2. Add a comment into the database stating the application was entered in error without a signature

Setting the Status of the Application

  1. There are several statuses available in the HCTC database for participants depending upon their application. If you are unable to change a status on an application, then refer to HCTC Coordinator or Entity Team Work Leader for elevation to P&A.

  2. Anytime a record is updated, use the following chart to determine the status for the application.

    If ... Then ... Applicable Letter
    The application packet is complete and acceptable and the applicant is eligible Move to Complete

    Note:

    If the participant is already in enrolled status, then no status change needed.

    IRM 3.11.29.13.6, Letter 4545, HCTC Enrollment Letter
    You are reviewing an application Move to Quality Review  
    Quality Review has been performed and the participant is able to be enrolled Move to Enrolled  
    Participant’s health plan is not qualified for the HCTC. This status will always take priority if we are corresponding for a HPA Vendor in addition to anything else. Processing—HPA Vendor Num Not Avail IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    Information on Form 13441-A or supporting documentation is defective, missing, incomplete, invalid, or illegible and the applicant is eligible. Processing—Waiting for Supporting Docs. IRM 3.11.29.13.5, Letter 4541, HCTC Candidate Insufficient Documentation - System Letter
    The application packet is incomplete or unacceptable, and the applicant is eligible but didn’t reply or inadequately replied to correspondence use paragraph 5 and/or paragraph 6 for Letter 4540. See IRM 3.11.9.13.4, Letter 4540, HCTC Notice of Ineligibility. Ineligible IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    The participant has been enrolled and is now requesting removal from the program Cancelled—Ineligible IRM 3.11.29.13.1, Letter 3772, End of Program Letter
    COBRA insurance has expired Cancelled—Ineligible IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility
    The participant had been enrolled and is no longer eligible Cancelled—Permanent Ineligibility IRM 3.11.29.13.1, Letter 3772, End of Program Letter
    None of the above scenarios are applicable Refer to the HCTC coordinator  

    Note:

    If both Letters 4540 and 4541 are needed, use Letter 4540 utilizing the open paragraph format. An applicant’s eligibility takes priority over defective items in an application. IRM 3.11.29.13.4.

    Note:

    Processing—HPA Vendor Num Avail status is currently not in use.

Systemically Generated Statuses of the Application

  1. Following are several statuses that are systemically generated by the HCTC database. If you disagree or believe a systemically generated status is erroneous, elevate to P&A.

    1. Form received

    2. Inactive

    3. Cancelled: Permanent Ineligibility - Over 65

    4. Ineligible - Over 65

    5. Cancelled: Ineligible - COBRA End Date Expired

    6. Ineligible - COBRA End Date Expired

    7. Cancelled: Ineligible - Prison File Match

    8. Ineligible: Could Not Validate TIN at This Time

    9. Cancelled - Ineligible: TIN Validation Failure

    10. Ineligible - QFM End Date Expired

    11. Cancelled:Ineligible QFM End Date Expire

  2. For the statuses in the table below, the database will automatically unenroll the participant. The participant must be notified 45 days prior to the loss of eligibility based on date entries in the fields listed in the table. See IRM 3.11.29.13.1, Letter 3772, End of Program Letter.

    Status Expiration Determined By
    Cancelled: Permanent Ineligibility - Over 65 Date of Birth
    Ineligibility - Over 65 Date of Birth
    Cancelled: Ineligible - COBRA End Date Expired End Date for COBRA coverage
    Ineligible - COBRA End Date Expired End Date for COBRA coverage
    Cancelled: Ineligible - QFM End Date Expired End Date for QFM
    Ineligible - QFM End Date Expired End Date for QFM
  3. When the database moves a previously enrolled participant into the status "Cancelled: Ineligible - Prison File Match" , elevate to Planning and Analysis for review.

Releasing / Filing Forms 13441-A, Batches

  1. Clerks review each Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, before releasing to Files and/or the storage area. They verify that all pages of Form 13441-A are present and supporting documents are attached.

  2. Each packet with Form 13441-A may contain one or more of the following:

    1. The original Form 13441-A

    2. An updated Form 13441-A

    3. Required supporting documentation: a copy of the participant’s health insurance bill dated within the last 60 days

    4. A copy of any correspondence sent to the applicant

    5. Any correspondence sent by or on behalf of the applicant

  3. Clerks verify that the PIN (Participant Identification Number) on the Enrollment letter matches the PIN on the first page of Form 13441-A.

  4. In the Batch Block Tracking System (BBTS), Clerks release Forms 13441-A and associated documents to Files and/or the storage area.

  5. Place each batch of Forms 13441-A, along with the Form 9856, Attachment Alert, and two copies of Form 3210, Document Transmittal, for the batch, into a gusset folder. On the tab of the gusset folder, write the range of PINs, the program name "HCTC," and the tax year of the applications.

  6. Route Forms 13441-A numbered with a PIN to Files or a designated storage area at the Austin Submission Processing campus to be held until retirement.

  7. Retain Forms 13441-A at the Austin processing center for three (3) years. After the end of the third year, retire Form 13441-A to the Federal Record Center (FRC) for an indefinite period. See IRM 3.11.29.25, Record Retention Requirements.

  8. Include an Application Identification Sheet (AIS) and highlight the correct PIN. The AIS is used to attach documents to the applicant’s packet.

Correspondence

  1. The Enrollment Team is responsible for sending the following letters.

    Letter Title Purpose
    3772 End of Program Letter To cancel participants HCTC registration
    4510 HCTC Reimbursement Request – Denial To deny request for reimbursement
    4511 HCTC Reimbursement Request - Insufficient Documentation Participant provided insufficient documentation
    4540 HCTC Notice of Ineligibility To notify participant of ineligibility
    4541 HCTC Candidate Insufficient Documentation – System Letter
    • Form 13441-A missing signature

    • Form 13441-A is incomplete

    • Supporting documents are missing or incomplete

    • Policy holder SSN is invalid

    4545 HCTC Enrollment Letter To notify participant of confirmed enrollment
    5758 Health Coverage Tax Credit Enrollment in Process See Note below
    5945 HCTC Reimbursement Approval Proof of eligibility
    5974 Annual HCTC Vendor Renewal Notification To remind HPA/TPA to annually certify to receive ACH payments
    6009 Refund of HCTC Payments To notify participant of refund of HCTC payments
    6011 Return of HCTC Funds To request funds from a participant

    Note:

    Letter 5758 is used at the discretion of management to acknowledge receipt of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and supporting documents. Management must authorize the use of letter 5758. Do not send this letter without explicit instructions from management.

  2. Do not save any correspondence containing participant’s Personal Identifiable Information (PII) to your desktop or personal storage drive.

  3. When it is necessary to correspond with taxpayers, correspondence should be professional (i.e., correct spelling, punctuation, and grammar).

  4. Correspondence letters are catalog letters available in pdf format in the Forms/Pubs/Products Repository of IRWeb.

  5. Correspond only after you have entered the entire Form 13441-A into the HCTC database, except for any correspondence for missing signature.

  6. Comments must be entered into the HCTC database for any correspondence sent to participants. Comments must include what letter was sent and why the letter was sent (correspondence conditions).

  7. All correspondence must include the participant’s PIN, except for correspondence for missing signature.

  8. Address all decedent correspondence to "Estate of" and the decedent’s name. (e.g., Estate of John Smith)

  9. One copy of all correspondence is attached to the applicable applicant package in Received Date order with the oldest stapled to the top. See IRM 3.11.29.4, HCTC Program General Information.

  10. All letters are subject to review by the Improvement Team.

  11. Retrieve E-faxes daily. Check the E-fax folder daily for replies/missing information. Print the reply and associate it with the original submission on suspense wall.

    Note:

    Faxes received from US Bank should be elevated to the HCTC Coordinator or Entity Team Work Leader for research.

  12. Each correspondence letter may trigger a change in the status of the application. See IRM 3.11.29.10, Setting the Status of the Application.

  13. Allow applicant 45 days for responding to correspondence. A reply is late on the 46th day after correspondence.

Letter 3772, End of Program Letter

  1. Letter 3772, End of Program Letter, informs participants they have been cancelled from the HCTC program. See Exhibit 3.11.29-5. See also IRM 3.11.29.10, Setting the Status of the Application.

  2. Change the status of the application to "Cancelled—Permanent Ineligibility."

Letter 4510, HCTC Reimbursement Request - Denial

  1. Letter 4510, HCTC Reimbursement Request – Denial, is a denial letter for the reimbursement request for the HCTC Advance Monthly Program. See Exhibit 3.11.29-6. There will be no status change when sending Letter 4510.

  2. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Participant Identification Number (PIN) beside "Dear HCTC Program participant"

    2. Month(s) the reimbursement is requested in the first paragraph

    3. Amount of the reimbursement request in the first paragraph

    4. Reason for denial (check box entry)

    5. Open paragraph with HQ pre-approved text, if needed

Letter 4511, HCTC Reimbursement Request - Insufficient Documentation

  1. Letter 4511, HCTC Reimbursement Request - Insufficient Documentation, is sent to request documentation for the reimbursement request Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form. See Exhibit 3.11.29-7. There will be no status change when sending Letter 4511.

  2. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Participant Identification Number (PIN) beside "Dear HCTC Program Participant"

    2. Open paragraph with HQ pre-approved text, if needed

Letter 4540, HCTC Notice of Ineligibility

  1. Letter 4540, HCTC Notice of Ineligibility, notifies participants their HCTC eligibility has not been processed. See Exhibit 3.11.29-8. See IRM 3.11.29.10, Setting the Status of the Application.

  2. Change the status in the database to one of the following, depending on the circumstances.

    • Processing—Waiting for Supporting Documentation

    • Processing—HPA Vendor Not Avail

    • Ineligible

  3. Letter 4540 is customizable with 14 selectable paragraphs on the following topics. Multiple paragraphs may be selected to appear in the same letter.

    1. Paragraph 1 - Dependent status

    2. Paragraph 2 – Disqualifying health insurance coverage

    3. Paragraph 3 – Age requirement (PBGC only)

    4. Paragraph 4 – Imprisonment

    5. Paragraph 5 – Incomplete registration form

    6. Paragraph 6 – Missing supporting documents

    7. Paragraph 7 – Spousal coverage

    8. Paragraph 8 – Unqualified health insurance coverage

    9. Paragraph 9 – Participant eligibility

    10. Paragraph 10 – Family member eligibility – Insufficient documentation

    11. Paragraph 11 – Family member eligibility – Unable to confirm eligibility

    12. Paragraph 12 – Family member eligibility – You are not eligible

    13. Paragraph 13 – Unable to verify Health Plan Administrator (HPA) set up

    14. Paragraph 14 – Miscellaneous missing information

  4. If both Letters 4540 and 4541, HCTC Candidate Insufficient Documentation - System Letter, are needed, use Letter 4540 utilizing the open paragraph format. An applicant’s eligibility takes priority over defective items in an application.

  5. If signature is missing, return the unsigned Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and all related documents to the applicant. See IRM 3.11.29.9.6, Inputting Form 13441-A, Part 6: Form Completion.

  6. If the signature is" X’d," crossed out, or lined through, either pre-printed or manually, return the original Form 13441-A and all related documents to the applicant with a blank Form 13441-A signature page.

  7. If you are not returning Form 13441-A to the applicant, remove the words "Enclosure: Your HCTC registration form" from page 2 of Letter 4540 prior to printing.

  8. The applicant’s response to Letter 4540 may cause changes to the participant’s status in the HCTC database.

    1. For an adequate response in which all required information is present and acceptable, update the information in the database to reflect the applicant’s response. See IRM 3.11.29.10, Setting the Status of the Application.

    2. For no response or an inadequate response in which required information is missing or unacceptable:

    • Set the status of the application to "Ineligible."

    • Send Letter 4540 with the relevant paragraph "Incomplete registration form" or "Missing supporting document," per the reason for the correspondence. If both reasons apply, send both explanations.

    • Utilize the open paragraph with HQ pre-approved text.

Letter 4541, HCTC Candidate Insufficient Documentation - System Letter

  1. Letter 4541, HCTC Candidate Insufficient Documentation - System Letter, notifies participants they are missing the required documentation to successfully establish eligibility. See Exhibit 3.11.29-9. See also IRM 3.11.29.10, Setting the Status of the Application.

  2. Change the status in the database to "Processing—Waiting for Supporting Documentation."

  3. The enrollment team sends an applicant Letter 4541 if Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, isn’t signed or is incomplete, the policyholder’s SSN is invalid, or supporting documents are missing or incomplete.

  4. If both Letters 4540, HCTC Notice of Ineligibility, and 4541 are needed, use Letter 4540 utilizing the open paragraph format. An applicant’s eligibility takes priority over defective items in an application.

  5. If signature is missing, return the unsigned Form 13441-A and all related documents to the applicant. See IRM 3.11.29.9.6, Inputting Form 13441-A Part 6: From Completion.

  6. If the signature is "X’d," crossed out, or lined through, either pre-printed or manually, return the original Form 13441-A and all related documents to the applicant with a blank Form 13441-A signature page.

  7. If you are not returning Form 13441-A to the applicant, remove the words "Enclosure: Your HCTC registration form" from page 2 of Letter 4541 prior to printing.

  8. The applicant’s response to Letter 4541 causes changes to the participant’s status in the HCTC database.

    1. For an adequate response in which all required information is present and acceptable, update the information in the database to reflect the applicant’s response. See IRM 3.11.29.10, Setting the Status of the Application.

    2. For no response or an inadequate response in which required information is missing or unacceptable:

    • Set the status of the application to "Ineligible."

    • Send Letter 4540, HCTC Notice of Ineligibility, with the relevant paragraph "Incomplete registration form" or "Missing supporting documents," per the reason for the correspondence. If both reasons apply, send both explanations. See IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility.

    • Utilize the open paragraph with HQ pre-approved text.

Letter 4545, HCTC Enrollment Letter

  1. Letter 4545, HCTC Enrollment Letter, notifies participants that their HCTC eligibility has been successfully processed. See Exhibit 3.11.29-10. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Enter the Participant ID number

    2. Enter the Monthly HCTC Payment in the field Amount due in the second paragraph

  2. Change the status in the database to "Complete" .

Letter 5758, Health Coverage Tax Credit Enrollment in Process

  1. Letter 5758, Health Coverage Tax Credit Enrollment in Process, is not used without the manager’s consent. Letter 5758 is used to acknowledge receipt of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, and supporting documents. Do not send this letter without explicit instructions from management. See Exhibit 3.11.29-11.

Letter 5945, HCTC Reimbursement Approval

  1. Letter 5945, HCTC Reimbursement Approval, notifies participants that their request for reimbursement on Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, has been approved and they should expect a payment within three weeks. See Exhibit 3.11.29-12. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Enter the Participant ID number

    2. Enter the reimbursement payment amount in the "$0.00" field in the second paragraph

Letter 5974, Annual HCTC Vendor Renewal Notification

  1. Letter 5974, Annual HCTC Vendor Renewal Notification, notifies Health Plan Administrator (HPA) or the Third-Party Administrator (TPA) that they must annually complete a Form 3881-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, to continue to receive Automatic Clearing House (ACH) payments from the HCTC program. See Exhibit 3.11.29-13. Along with the standard address, date, and last four digits of the vendor’s EIN (in the Taxpayer ID Number box) enter the following:

    1. Enter the HPA/TPA name

    2. Enter a due date in the "[insert date]" prompt in the third paragraph

Letter 6009, Refund of HCTC Payments

  1. Letter 6009, Refund of HCTC Payments, notifies participants that they will be receiving a refund of payments for applicable months. See Exhibit 3.11.29-14. Along with the standard address, date, and last four digits of the participant’s SSN, enter the following:

    1. Enter the Participant Identification number (PIN).

    2. Enter the HCTC Program participant name following "Dear HCTC Program participant:"

    3. Use the drop-down box to make the appropriate selection of "month" or "months."

    4. Enter the name of the appropriate month(s) in the "[enter months]" prompt. Enter exactly as it will appear in the body of the letter.

    5. Enter the amount of payment being returned to the participant in the "[123,456.00]" prompt. Include comma separators for thousands (if needed) and cents. Enter exactly as it will appear in the body of the letter.

    6. If needed, utilize the open paragraph with HQ pre-approved text.

Letter 6011, Return of HCTC Funds

  1. Letter 6011, Return of HCTC Funds, is sent by HQ analysts to a participant to request the return of HCTC monies for any of the following reasons:

    1. Administrative Error

    2. Repayment of Other Benefits

    3. PIN Mismatch

    4. Other

  2. The HCTC participant is requested to send a check to the HCTC CFO Beckley Finance Center.

  3. Documentation may be sent to the Enrollment Team, by the participant, and should be elevated to P&A.

  4. HQ will review the documentation and will send it back to the Enrollment Team to be attached to the participant’s file.

Form 4442, Inquiry Referral

  1. Form 4442, Inquiry Referral, is sent to the Enrollment Team by either Accounts Management (AM) or the P&A analyst.

    Note:

    Items received from Lockbox will be treated as Forms 4442.

  2. Correspondence and faxes received directly from participants and administrators should be processed by the enrollment team following Form 4442 instructions.

  3. When Form 4442 is regarding a payment issue or Form 1099-H and was received from AM, elevate to the P&A analyst.

  4. When Form 4442 is received, and does not regard a payment issue, then process as requested.

    • Research the issues to determine why the inquiry was generated

    • Respond as appropriate

    • Document within the database with comments. See IRM 3.11.29.4, HCTC Program General Information.

  5. When forwarding Form 4442 to AM, include a copy of any correspondence (member, third party, etc.) to assist customer service representatives (CSRs) when responding back to HCTC participants.

  6. Return Form 4442 to the originator if:

    1. The person named in Form 4442 isn’t in the database

      Exception:

      If the information attached is related to a Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, returned because an earlier submission wasn’t signed or the SSN was invalid; the Form 4442 should be processed.

    2. Form 4442 doesn’t provide enough information to determine relevance, intention, or identify the applicant

    3. Form 4442 was sent to the Enrollment Team in error

  7. Form 4442 must be attached to the back of Form 13441-A. See IRM 3.11.29.4, HCTC Program General Information.

Qualified Family Member Participant (QFMP) Under Certain Provisions

  1. For the purposes of the HCTC, a Qualifying Family Member (QFM) is:

    1. The participant’s spouse

    2. The participant’s dependent with respect to whom the participant is entitled to a deduction on their Federal income tax return under section 152 of Title 26 of the US Code

  2. A QFMP must meet the same general requirements as a primary participant.

  3. Legislation allows for the continuation of HCTC benefits for QFMPs for up to 24 months after the eligible primary individual achieves the following certain events: Medicare eligibility, divorce, or death.

  4. QFMP due to Medicare Eligibility – In most cases, an individual becomes eligible for Medicare the first day of their birth month the year they turn 65. An individual will remain HCTC eligible their entire birth month in which they turn 65.

    1. Form 13441-A for enrollment must be completed and signed by either the primary PBGC/TAA recipient eligible for Medicare or the QFMP.

    2. A Medicare enrollment letter, Medicare card, or documentation showing the PBGC/TAA recipient is eligible or enrolled in Medicare is required.

      Note:

      Requirement "b" is removed if the QFMP was previously enrolled under the new Medicare eligible participant who is now or has previously un-enrolled citing Medicare eligibility, or we can determine by the date of birth that the Medicare eligible participant is 65 or older.

  5. QFMP due to Divorce – In the case a divorce between an eligible participant and spouse, the spouse is treated as an eligible individual beginning in the month of divorce if the spouse was a qualifying family member immediately before the divorce and had a separate coverage. If the spouse was a QFM immediately before the divorce and did not have separate coverage, the spouse is treated as an eligible individual beginning with the month after the date of divorce.

    1. The enrollment form must be completed and signed by the QFMP and will be enrolled in their name

    2. A divorce certificate, or similar legal documentation, is required for the PBGC payee or TAA recipient and must include the date of divorce

  6. QFMP due to Death – In the case of the death of an eligible participant, beginning with the month of the date of the death for individuals on separate coverage or with the month after the date of the death for individuals not on separate coverage:

    1. Any spouse of the participant (determined at the time of death) is treated as an eligible individual

    2. Any individual who was a QFM immediately before such death is treated as an eligible individual

    3. The enrollment form must be completed and signed by the QFMP and will be enrolled in their name

    4. A death certificate, or similar documentation, is required for the PBGC payee or TAA recipient that includes the date of death

  7. Box 5 on the instruction’s page 1 of Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, for registering as a QFM may be checked. A review of the form could also determine it is for a QFMP and will be processed as such, even if the box is not checked.

  8. If a QFMP was previously enrolled under an eligible participant, edit an action trail on both forms. Reference the QFMP PIN on the eligible participant form and reference the eligible participant PIN on the new QFMP form in the top left margin.

  9. A QFMP is only eligible for 24 months from the date of the qualifying event which granted them eligibility. Use the documentation verifying the qualifying event to determine the start date for QFM. If you cannot determine the start date see IRM 3.11.29.13.4, Correspondence Letter 4540.

Processing Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form

  1. Taxpayers can request 72.5% reimbursement for premiums they paid directly to their administrator while waiting to be accepted into the Advance Monthly Program by using Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form.

    Note:

    If an unprocessed 14095 is attached to Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, refer to the HCTC Coordinator or Entity Team Work Leader.

  2. The Enrollment Team will pull the original Form 13441-A and attach to the Form 14095.

  3. The HCTC Coordinator or Entity Team Work Leader will notify P&A as Forms 14095 are received in the unit.

  4. P&A will research, process, and elevate any discrepancies to HQ.

    1. HQ will determine the cause of the variance. If the cause can be determined, the amount should be corrected to reflect the database amounts when possible.

    2. Where HQ cannot determine the cause, the participant is reimbursed based on the attached proof of payment in conjunction with what is on the Form, ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ .

    3. In the instances where it is obvious that the taxpayer has paid less than their total premium amount for any month, the participant is reimbursed the substantiated amount.

    4. If the variance is greater than the tolerance correspondence is needed. See IRM 3.11.29.13, Correspondence.

  5. After processing is complete, P&A will return forms to the Enrollment Team for batching and correspondence.

  6. Any required correspondence will be determined by P&A and forwarded to the Enrollment Team. The Enrollment Team will generate the correspondence and add comments to the HCTC database. See IRM 3.11.29.13, Correspondence and IRM 3.11.29.4, HCTC Program General Information.

  7. On the 15th and 30th of each month, after HQ approval, the P&A Analyst will forward the spreadsheet to the public mailbox ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ to be processed. If either the 15th or 30th fall on a non-business day, spreadsheet submission takes place on the business day immediately prior.

  8. Submit the spreadsheet to CFO with the following information:

    "The attached spreadsheet represents payment to participants who submitted Forms 14095. The (Month) (15th or 30th), 201X submission to CFO represents a total of $(Amount) for reimbursements of the 72.5% portion of the health insurance."

    "Retroactive Refunds, the government portion, Fund R0923HTC"

  9. After payments have been confirmed, P&A will provide substitute Forms 4442, Inquiry Referral, for the Enrollment Team to add comments to the HCTC database. See IRM 3.11.29.4, HCTC Program General Information.

  10. Due to program constraints, Forms 14095 have an annual cutoff of October 1st and will resume after the beginning of the new year. Any reimbursement requests with a Received Date stamp after October 1 will need to be claimed on the participant’s federal tax return using Form 8885, Health Coverage Tax Credit.

  11. Forms 14095 with a Received Date stamp after October 1 for the current processing year will be returned to the participant with Letter 4510, using the open paragraph for the October cutoff date. See IRM 3.11.29.13.2, Letter 4510, HCTC Reimbursement Request - Denial.

Form 14095, Part 2: Determine Eligibility and Request Reimbursement

  1. P&A will verify the following from Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, with information in the HCTC database.

    1. The participant is eligible for the requested reimbursement month(s) while they were enrolling in the Advance Monthly Program (AMP) or chose not to be in the AMP program. Reimbursement can only be for January through September of the current calendar year.

      Note:

      Credit for October through December will need to be claimed on the participant’s Federal tax return using Form 8885, Health Coverage Tax Credit.

    2. The requested reimbursement months were for months the participant did not receive monthly program payments through their Health Plan Administrator (HPA) or Third Party Administrator (TPA).

Form 14095, Part 3: Gathering Supporting Documents

  1. Participants must provide a health insurance bill or payment coupon from the Health Plan Administrator (HPA) or Third Party Administrator (TPA) for the months identified in Part 2 of Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form. These documents must contain the following information:

    1. Name of the participant

    2. Social Security Number (SSN) of the policy holder if different from requestor

    3. Name of health plan

    4. Monthly premium amount

    5. Dates of coverage

    6. Health plan ID number including one of the following:
      - Member ID
      - Group ID
      - Policy ID
      - Plan ID

  2. Proof of payment must indicate the amount paid and to whom it was paid. Proof of payment includes evidence of full payment of premiums, such as bank statement, copies of checks, credit card statements, or receipts for money orders.

  3. If the participant is not eligible for a retroactive payment, leave a comment in the HCTC database specifically stating why they are not eligible and correspond. See IRM 3.11.29.13, Correspondence.

  4. Attach forms and letters to the back of the participant’s original Form 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, as instructed in IRM 3.11.29.4, HCTC Program General Information.

Form 14095, Part 4: Sign and Date This Form

  1. Form 14095, The Health Coverage Tax Credit (HCTC) Reimbursement Request Form, must be signed. If form 14095 is not signed:

    1. Correspond with Letter 4511, HCTC Reimbursement Request - Insufficient Documentation. See IRM 3.11.29.13.3.

    2. Leave comments in the HCTC database specifically stating what is missing.

    3. File on suspense wall or designated area.

Replies to Form 14095, The Heath Coverage Tax Credit (HCTC) Reimbursement Request Form

  1. Replies to correspondence for Form 14095, The Heath Coverage Tax Credit (HCTC) Reimbursement Request Form, should be elevated to P&A.

  2. P&A will review replies and return forms to the Enrollment Team for batching and correspondence.

SF-1034, Public Voucher for Purchases and Services other than Personal, Monthly Payment Reconciliation

  1. Each month the Department of Treasury transmits 100% of the insurance premium payments to the Health Plan Administrator (HPA) or Third-Party Administrator (TPA) through a payment file for all enrolled participants associated with the HPA/TPA’s vendor number. This payment file is used to reconcile payments for each participant.

  2. If after reconciliation it is discovered participants had an unapproved vendor, duplicate payments, misapplied payments, were using an incorrect Participant Identification Numbers (PIN), among other instances, then HPA/TPA/Individuals may be refunded their 27.5% portion of the insurance premium. This reimbursement is processed with a Standard Form 1034, Public Voucher for Purchases and Services other than Personal.

  3. Payment reconciliation is handled on a case-by-case basis by P&A and HQ with two different processes: individuals and vendors.

  4. For individuals, the reimbursement process is completed by P&A on a spreadsheet and goes through HQ for approval. After approval, the spreadsheet is submitted to CFO by P&A.

    1. When submitting the spreadsheet to CFO, use the following information:

      "The 1034 spreadsheet represents HCTC payments to participants based on reconciliation. The spreadsheet submission for (month day), 201(X) is a total of $(amount) in payments of the 27.5% portion of their health insurance. Fund R6163HTC."

    2. For individuals, the spreadsheet is submitted using:
      Vendor number 02020069
      Fund R6163HTC

  5. Once the SF-1034 reimbursement spreadsheet for individuals has been submitted to CFO, it will be provided to the Enrollment team for batching so that comments can be added to the database notating the issuance of the 1034 payments.

  6. For vendors, the reimbursement process is completed by the Enrollment Team Work Leader with direction from HQ and goes through a routing path for approval. After approval, Standard Forms 1034 are submitted to CFO by the Enrollment Team Work Leader.

  7. The Austin Submission Processing designated authorized certifying officers for vendor’s SF-1034 are as follows:

    1. Primary
      Cornell "Tee" Turner, Operations Manager, DPO

    2. Back-ups
      Maureen Varnado, P&A Chief, SP
      Steve Harmon, P&A Manager, SP

  8. The 1034 reimbursements will be added to the payment file within the HCTC database by P&A.

  9. If the Enrollment Team is contacted regarding a reconciliation issue, elevate to P&A.

    Figure 3.11.29-7

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    Please click here for the text description of the image.

Completing SF-1034

  1. Use the following information, to complete SF-1034 for vendor reimbursement. See Figure 3.11.29-7.

    • Input the voucher number in the format of HPA/TPA MM-YYYY (M=month Y= year). For example, BCBSM 01-2017.

    • U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION – HCTC Program – Austin Enrollment Team

    • DATE VOUCHER PREPARED – Enter date voucher is prepared

    • CONTRACT NUMBER AND DATE, REQUISITION NUMBER AND DATE, SCHEDULE NO, and PAID BY– Leave Blank

    • DATE INVOICE RECEIVED – Enter date voucher is prepared

    • DISCOUNT TERMS – Leave Blank

    • PAYEE’S ACCOUNT NUMBER – Enter the vendor’s employer identification number (EIN)/taxpayer identification number (TIN)

    • PAYEE’S NAME AND ADDRESS – Enter the vendor identification number followed by vendor’s name and address. For example:
      Vendor Number 00012345
      John Doe Insurance
      123 Main Street.
      Anytown, TX 78704

    • SHIPPED FROM, TO, WEIGHT, GOVERNMENT B/L/ NUMBER, NUMBER AND DATE OF ORDER (column), and DATE OF DELIVERY OR SERVICE (column) – Leave Blank

    • ARTICLES OR SERVICES (column) – Enter a description for the reimbursement, the date of the return of funds (if available), the program name (HCTC AMP (Advance Monthly Payment)), and a breakdown of the government’s percentages and the participant’s percentage. For example:
      Payment to (vendor) to reconcile (month(s)).
      Return of Funds from (vendor) on (date)
      HCTC AMP
      27.5% portion = (calculate 27.5% of total)
      72.5% portion = (calculate 72.5% of total)

    • QUANTITY (column) and UNIT PRICE (column) – Leave Blank

    • AMOUNT – Enter amount of reimbursement

    • TOTAL – Enter total amount of reimbursement. This amount must match the APPROVED FOR amount.

    • PAYMENT (check boxes) – Leave Blank

    • APPROVED FOR – Enter the amount of reimbursement. This amount must match the TOTAL amount.

    • EXCHANGE RATE, DIFFERENCES, BY(2), and TITLE– Leave Blank

  2. ACCOUNTING CLASSIFICATION Section

    1. Enter the appropriate Accounting Classification Codes provided by CFO for the 72.5% appropriation account.

      Example:

      For the 72.5% appropriation account use the following:


      Fund: R0923HTC
      Commitment: 41
      Funds Center RA04
      Functional Area - RMAD
      Order - CHTC
      Business Area – 0002

    2. Enter the appropriate Accounting Classification Codes provided by CFO for the 27.5% appropriation account.

      Example:

      For the 27.5% appropriation account use the following:


      Fund: R6163HTC
      Commitment: 2400
      Funds Center RA04
      Functional Area - RMAD
      Order - CHTC
      Business Area – 0002

Form 8885, Health Coverage Tax Credit

  1. Any documentation related to Form 8885, Health Coverage Tax Credit, received in the Entity unit should first be reviewed to determine if it is related to the Advanced Monthly Program or Form 1040.

    1. If the documentation was sent in support of the Advanced Monthly Program it should be processed following standard HCTC procedures.

    2. If the documentation was sent in support of Form 1040, route to CIS/AM.
      - Edit "(HCTC)" in the left margin
      - Place in your route-out folder

Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC

  1. Health Plan Administrators (HPA) and Third Party Administrators (TPA) must be able to receive payments via Electronic Funds Transfer (EFT) processed through the Direct Deposit Program as an Automated Clearing House (ACH) payment.

  2. HPAs/TPAs must be enrolled in the EFT program to receive insurance premium payments for their customers who are participants in the HCTC program. Receiving electronic payments ensures timely, accurate payments and reduces the risk of payments being misdirected within the HPA/TPA’s organization.

  3. HPAs and TPAs must complete Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC, to enroll and begin receiving HCTC payments. If a vendor is not set-up as an approved HCTC vendor, correspond with Letter 4540 using selectable paragraph 9. See IRM 3.11.29.13.4, Letter 4540, HCTC Notice of Ineligibility.

  4. Once a HPA/TPA has sent Form 3881-A and is established to receive payments, they do NOT need to submit another Form 3881-A if additional individuals enroll after the HPA/TPA is established.

  5. However, a HPA/TPA must recertify each year by submitting a new Form 3881-A. See IRM 3.11.29.20.2, Recertifying with Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC.

Submitting and Updating Form 3881-A

  1. Form 3881-A, ACH Vendor / Miscellaneous Payment Enrollment – HCTC, is processed by the HCTC Coordinator or Entity Team Work Leader. If attached to an application, elevate to the Coordinator or Work Leader.

  2. Form 3881-A may be received through the Stakeholder mailbox, submitted with an application, or sent through the mail. If a physical form is sent in, scan the form and e-mail it to yourself.

  3. Once there is an electronic version of Form 3881-A, verify the following information is included:

    • Agency Information Federal program agency

    • Agency Information Agency Identifier

    • Agency Information Agency Location Code (ALC)

    • Agency Information ACH format (checkbox)

    • Agency Information Address

    • Payee Name

    • Payee SSN or Taxpayer ID number

    • Payee Address

    • Payee Contact person name

    • Payee Contact e-mail address

    • Payee Telephone number

    • Financial Institution Name

    • Financial Institution’s Telephone number

    • Financial Institution Nine-digit routing transit number

    • Financial Institution Depositor account number

    • Financial Institution Type of account

    • Financial Institution Signature of authorized official

    • Financial Institution Title of authorized official

    • Financial Institution Telephone number of authorized official

  4. If any of the above information is missing, elevate to P&A. P&A will work with HQ to obtain the required fields.

  5. Once the form is complete, forward, via secure e-mail using IRS IT-approved encryption technology, to the following contacts FROM THE STAKEHOLDER’S MAILBOX:

    1. *CFO BFC Electronic Obligations <CFOBFC.ElectronicObligations@irs.gov>

    2. Aliff Rose M <Rose.M.Aliff@irs.gov>

    3. Bahr Kevin <Kevin.Bahr@irs.gov>

    4. *W&I HCTC STAKEHOLDER ENGAGEMENT <WI.HCTC.Stakehldr.En@irs.gov>

      Note:

      If the form is forwarded from your personal e-mail, it will not be accepted and will be sent back.

      Note:

      Refer to IRM 10.5.1, Privacy Policy, for guidance on the use of IRS IT-approved encryption technology when conducting IRS official business.

  6. Once CFO assigns a vendor number, save and upload Form 3881-A to the Form 3881-A HCTC Vendor folder located on the HCTC SharePoint.

Recertifying with Form 3881-A

  1. Health Plan Administrators (HPA) and Third Party Administrators (TPA) must recertify annually to receive insurance payments from their participants via Electronic Funds Transfer (EFT) through the Direct Deposit Program as an Automated Clearing House (ACH) payment by submitting a new Form 3881-A.

  2. For Recertification:

    1. HQ Analysts will receive monthly notifications of expiring vendors from Beckley Finance Center via the HCTC Stakeholder mailbox.

    2. HQ Analysts will provide a one-month notification to P&A either through e-mail or spreadsheet of upcoming renewals.

    3. P&A will issue notifications as Forms 4442, Inquiry Referral, to the Enrollment Team. See IRM 3.11.29.14, Form 4442, Inquiry Referral.

    4. The Enrollment Team will generate a Letter 5974, Annual HCTC Vendor Renewal Certification, for the HPA/TPA. See IRM 3.11.29.13.9, Letter 5974.

    5. The Enrollment Team will batch the notifications as Forms 4442. See IRM 3.11.29.14.

    6. The Enrollment Team will notify P&A of completion and HQ will monitor the renewals.

Payment Submission / Lockbox / Daily Mail-Out Package

  1. HCTC participants are instructed to send their payments to a lockbox depository for payment processing.

  2. If payment(s) received at the lockbox require additional information to process, such as a missing or invalid PIN, Lockbox will request the missing information from the Enrollment Team, via fax by 12:00 p.m. CST daily.

  3. The Enrollment Team will research the HCTC database for missing information/invalid PIN and provide a response to Lockbox by 10:00 a.m. CST the next business day ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ .

  4. If the Enrollment Team supplies sufficient information for the missing/invalid PIN, the Lockbox site will process the remittance.

  5. If a valid PIN number cannot be located, Lockbox will reject the payment back to the participant with all original contents.

  6. The Lockbox site will return rejected payments/unprocessable items back to the participant, with a reject letter. A copy of the reject letter and all contents that were mailed to the participant will be sent from Lockbox to the Enrollment Team, with a Form 3210, Document Transmittal, as part of a daily mail out package.

  7. As part of the daily package mail-out to the Enrollment Team, Lockbox will include correspondence items and envelopes received at the Lockbox site in which the site processed the participant’s remittance. Correspondence includes an item received that is not a payment coupon or remittance.

  8. The Lockbox site must use an approved dedicated overnight private delivery/ freight service (e.g., FedEx, DHL, and UPS) to deliver shipments to the Enrollment Team.

  9. Once the shipment is received, the Enrollment Team will:

    1. Verify the contents were received and sign the acknowledgment copy of the Form 3210. The Enrollment team will return the signed, dated and acknowledged Form 3210, to the Lockbox site by 2:00 p.m. local time, ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ .

    2. Batch the content as Form 4442s. See IRM 3.11.29.14, Form 4442, Inquiry Referral.

  10. If Lockbox does not have a daily mail out package to send to the Enrollment Team, they will send an e-mail to the Stakeholder mailbox to advise there is no mail out package.

Insufficient Funds Notification

  1. Lockbox will send an e-mail to the Stakeholder mailbox when insurance premium payments have been returned due to insufficient funds.

  2. Insufficient Funds are worked by P&A and HQ.

Unprocessables / Rejects

  1. Lockbox will send the daily Payment Reject Letter Tracking Report, copies of the reject letter, and correspondence to the Enrollment Team. See IRM 3.11.29.21, Payment Submission / Lockbox / Daily Mail-Out Package and IRM 3.11.29.26, Daily Reports.

  2. The Rejected payments are worked by P&A and HQ.

  3. Once official notification of rejected payments is received, the payments are added to the Return of Funds (RoF) spreadsheet and tracked for the 27.5% reimbursement allowed on Standard Form 1034, Public Voucher for Purchases and Services other than Personal. See IRM 3.11.29.18, SF-1034, Public Voucher for Purchases and Services other than Personal, Monthly Payment Reconciliation.

  4. Once payments are researched to determine both the cause of the return and where the payment should now be applied, they are added to the database by P&A and comments are added or updated in the database.

Operations Assistance Request (OARs)

  1. Operations Assistance Request (OARs) from Taxpayer Advocate Services are normally received through the Stakeholder mailbox (*W&I HCTC STAKEHOLDER ENGAGEMENT <WI.HCTC.Stakehldr.En@irs.gov>) and are worked by P&A.

  2. If any OARs are received outside of the Stakeholder mailbox, refer to the HCTC Coordinator or Entity Team Work Leader to be elevated to P&A.

Record Retention Requirements

  1. Forms 13441-A, Health Coverage Tax Credit (HCTC) Monthly Registration and Update, must be retained in AUSP Files or designated area for three (3) years, then retired to the Federal Record Center (FRC) to follow the Record Retention requirements for Document 12990, Records and Information Management Records Control Schedules.

  2. The Lockbox site must capture an image of the front and back of all remittances and the payment posting documents (vouchers, facsimiles, remittance photocopies) for all transactions they process.

    1. The Lockbox site must retain electronically processed remittances for a period of five (5) business days after the electronic check processing (ECP) settlement date. These documents must be kept in a manner that is easily retrievable.

    2. The Lockbox site must retain paper vouchers or payment posting documents/ facsimiles/photocopies for a period of five (5) business days after the ECP settlement date. These documents must be kept in a manner that is easily retrievable.

    3. RTR (Image) files must be retrievable for a period of 30 calendar days from creation.

Daily Reports

  1. The following daily reports are prepared and submitted by Lockbox through the Stakeholder mailbox.

    1. Daily Deposit Production Report

    2. Payment Reject Letter Tracking Report

  2. The Daily Deposit Production Report shows payments processed and other activity, such as overpayments.

  3. The Payment Reject Letter Tracking Report must include the following:

    1. The date the reject letter was mailed to the participant by Lockbox

    2. Participant’s last name

    3. Participant Identification Number (PIN)

    4. A reason the item was rejected (A-H)

    5. A daily count of the rejected items

  4. If the reject reason is "H" (other), a comment must be added to explain the reason the payment was rejected. If payment was rejected for an invalid or missing PIN (Reason Code D) and faxed to the Austin Enrollment Team, the date and time of fax is entered.

  5. The Lockbox Site must retain copies of rejected items such as reject letters, original payment coupons, remittances and correspondence on site for one year in retrievable format to support responses to government inquiries.

Weekly Reports

  1. There are three weekly reports for the HCTC program: Weekly Statistical Report, HCTC Production Report, and the HCTC Weekly Refund Report.

  2. Weekly Statistical Report. The report is received every Monday morning from the HCTC Coordinator or Entity Team Work Leader to provide weekly data on HCTC volumes.

  3. HCTC Production Report. This report is received from P&A each Monday.

  4. HCTC Weekly Refund Report. This report is received weekly from Beckley Finance Center and is used by HQ and P&A to reconcile payments. The report shows return of funds from Health Plan Administrators (HPAs)/ Third Party Administrators (TPAs). It is received with a zero balance if there are no return of funds for the week.

HCTC TAA, ATAA, and RTAA Certification Document

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Pension Benefit Guaranty Corporation (PBGC) Letter of Acknowledgment

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Pension Benefit Guaranty Corporation (PBGC) Pension Verification Letter

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Example of Form 1099-R

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Letter 3772 - End of Program Letter

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Letter 4510 - HCTC Reimbursement Request Denial

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Letter 4511 - HCTC Reimbursement Request - Insufficient Documentation

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Letter 4540 - HCTC Notice of Ineligibility

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Letter 4541 - HCTC Candidate Insufficient Documentation - System Letter

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Letter 4545 - HCTC Enrollment Letter

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Letter 5758 - Health Coverage Tax Credit Enrollment in Process

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Letter 5945 - HCTC Reimbursement Approval

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Letter 5974 - Annual HCTC Vendor Renewal Notification

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Letter 6009 - Refund of HCTC Payments

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Letter 6011 - Return of HCTC Funds

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