Application for Exemption from the Shared Responsibility Payment for Individuals who Experience Hardships

Starting in 2014, every person needs to have health coverage or make a payment on their federal income tax return called the “shared responsibility payment". If you aren’t sure, you may want to ask for an exemption.

Some people are exempt from making this payment. This application includes one category of exemption. There are other applications for other categories of exemptions. You may apply for certain other categories of exemptions when you file your federal income tax return.

You don’t need to ask for an exemption if you’re not going to file a federal income tax return because your income is below the filing threshold.

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