Form for Securely Submitting Social Security Number

Social Security Number Submission Form

If you had Health insurance for any part of the year, please provide the requested information

The Affordable Care Act requires most U.S. citizens to have health insurance or face penalties on their federal income taxes. To verify coverage, the IRS requires insurers to submit a report that identifies each member of its health plan. To assist the IRS in accurately verifying an individual’s coverage, insurers must include members’ Social Security numbers in their report.

Learn more about this IRS reporting requirement.

Please fill out the following form. Include everyone covered under your policy. You can add additional people with the +Add Member button.

Personal Information

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