Jump to content
ATX Community

ACA Questionnaire


JJStephens

Recommended Posts

Have any of you seen any decent/concise ACA questionnaires to help us gather the info needed to do a return?

 

I've seen a few but they were either way too simplistic (two or three questions like 'did you have insurance during 2014?) or two-page decision tree monsters. Not looking for too soft or too hard--looking for just right!

Link to comment
Share on other sites

  • 2 weeks later...

2014 Health Care Coverage Questionnaire

Name:                                          SSN:

List by name and SSN as shown on tax return or member of your household and answer YES or NO for each person:

YES      NO       Had health care Coverage:
YES      NO       For the entire year.
YES      NO       For part of the year (Less than 12 months) And which month(s)
YES      NO       No healthcare coverage at all



YES      NO       Did anyone besides taxpayer or spouse pay for health care coverage for anyone listed above?

YES      NO       Did you pay for health care coverage for anyone not listed above?
If you had coverage for any part of the year:
Where was the policy obtained?
Employer / Medicare / Medicaid / Marketplace(Exchange) / Other

If you didn't have coverage part or all of the year: Answer YES if it applies to any member of the household

YES      NO      Was your previous insurance policy cancelled in 2014?
YES      NO      Do you have an Exemption from the Marketplace (also called the Exchange)?
YES      NO      Was coverage offered by taxpayer's or spouse's employer?
YES      NO      Are you a member of a federally-recognized Indian tribe?
YES      NO      Are you eligible for services through an Indian health care provider?
YES      NO      Are you a member of a health care sharing ministry?
YES      NO      Did you live in the United States the entire year?
YES      NO      Are you enrolled in TRICARE?
YES      NO      Did you apply for CHIP coverage?
YES      NO      Do any of the following apply to you? Do NOT indicate which one.
                               Became homeless
                               Evicted in the past six months, or facing eviction or foreclosure
                               Received a shut-off notice from a utility company
                               Recently experienced domestic violence
                               Recently experienced the death of a close family member
                               Recently experienced a fire, flood, or other natural or human-caused disaster that resulted in substantial damage to your property
                               Filed for bankruptcy in the last six months
                               Incurred unreimbursed medical expenses in the last 24 months that resulted in substantial debt
                               Experienced unexpected increases in essential expenses due to caring for an ill, disabled, or aging family member

 

 

 

 

Not sure if community moderator will allow following PDF to remain, however, it is a formatted version of above common questions as created by Drake for their 2014 organizer.  ETA by jklcpa - you already know the answer is "NO" to that since you've already seen that I deleted the same pdf attachment in your post in general chat. DWR CPA answer to jklcpa ETA: No, I didn't know for sure because the original PDF was a scan of the page I received and the updated PDF I posted was one I cleaned up using Microsoft Word.

[deleted]

Edited by David Ristau CPA
deleted pdf
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Restore formatting

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
  • Recently Browsing   0 members

    • No registered users viewing this page.
×
×
  • Create New...