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Modesto California Form 8965: What You Should Know

The tax office of Stanislaus County, California, offers a special program that provides free tax information in English and Spanish to qualified Californians. The information may be used to calculate the credit amount, file tax returns, claim a refund, or provide information for an application for a hardship exemption. This form is a summary of the entire form. You'll need to complete the complete form. You can find the complete form, along with other forms that are related, in the links above. There is also a detailed form if you are a business owner with health insurance. This form lists health insurance coverage for you, your spouse at the time of filing, and the employee(s) you wish to claim as a dependent. You must complete the entire form, although it can be filed on its own without having to file an official document with all of its information. (See the instructions in the link above.) If you are claiming your own health insurance, make sure to: Complete and sign the form Complete an “Affidavit of Self Indemnification” on your own behalf, stating the details about the liability for the health insurance. (You may use a previous, separate form to get up to date information, but you must submit an affidavit, so you can claim damages if you are sued.) Complete a “Statement of Employer-Provided Health Insurance” that includes this section: “Your health insurance and your personal liability depend on the fact that you work for a small business.” You may use another document (such as a previous version of the form) as long as it: Does not have any information that changes any information in the “Affidavit of Self Indemnification;” Is clear and to the point; You can use a previous form as long as it: Contains any information that differs from the form that you use now; and Contains the name of the individual who is responsible for the employer-provided health insurance. (See examples of possible language here.) Also included with the tax form are these “Tax Preparedness and Prepaid Medical Expenses” (TEPEE) pages Also included with the tax form are these “Tax Preparedness and Prepaid Medical Expenses” (LT RME) pages You must submit these pages prior to the date when you'll be filing your tax return.

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