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Get Form Number 13704

Overage Tax Credit (HCTC) account. When you or your family members are enrolled in the monthly HCTC program, you must inform us of all changes that affect your eligibility, your family members, and your health insurance. If you do not keep your HCTC account information current, you could risk losing the Monthly HCTC. Instructions: 1. 2. 3. 4. 5. 6. 7. Keep a blank copy of this form in your personal records for future use. This form can also be found at www.irs.gov/hctc. Only use this form if y.

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