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  1. Home
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  6. Form 14199

Form 14199

  1. Country USA
  2. Language English
  3. Activity Taxes
  4. Department Internal Revenue Service
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Form 14199

COBRA Recapture Statement

Rev. January 2011

The document is a Form 14199 (Rev. 1-2011) related to COBRA premium assistance recapture for the tax year 2009. The taxpayer certifies that they did not meet the requirements as explained in the enclosed letter and Publication 502. They provide their name, Social Security number, daytime telephone number, and sign the form under penalty of perjury.

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Tax forms

Form 14199 is one of Tax forms that are documents used to report information related to taxes to the relevant tax authority. There are various types of tax forms, including federal, state, and local tax forms, which can vary depending on the taxpayer's circumstances and location.

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SEE ALSO
  • Form 990-W - Estimated Tax on Unrelated Business Taxable Income for Tax-Exempt Organizations (and on Investment Income for Private Foundations)
  • Form 5434 - Joint Board for the Enrollment of Actuaries Application for Enrollment
  • Form 6627 - Environmental Taxes
  • Form 14652 (Russian Version) - Civil Rights Complaint (Russian Version)
  • Form 9549 - Explanation of Other Income
  • Form 14017 - Application for Fast Track Settlement
  • Form 14157 (Spanish Version) - Return Preparer Complaint (Spanish Version)
  • Form 706-GS(D) - Generation-Skipping Transfer Tax Return For Distributions
  • Form 8888 - Allocation of Refund (Including Savings Bond Purchases)
  • Form 2063 - U.S. Departing Alien Income Tax Statement
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