Step 12 - Health Insurance Checkbox and Signature
Line 42
By checking this box, you are authorizing IDOR to share your contact, income and other information from this return with the Illinois Department of Insurance. This information will be used to determine your options for affordable health insurance coverage through Get Covered Illinois, the state’s Health Insurance Marketplace.
Check the “Self” box if the primary taxpayer (yourself) is uninsured. Check the “Spouse” box if the primary taxpayer’s spouse is uninsured. Check the “Dependent(s)” box if one or more of the primary taxpayer’s dependent(s) is uninsured. Check all boxes that apply.We will send you a letter with information about Illinois health insurance benefit options.
Get Covered Illinois will mail you information about your eligibility for affordable health insurance coverage. If you provide your email address in Step 1, Get Covered Illinois will send you this information via email.
If you are uninsured, you may qualify to enroll in health coverage now. For more information about Get Covered Illinois, go to GetCoveredIllinois.gov.
The information shared with the other state agencies will be kept confidential and used only in determining your eligibility for these health coverage.
Sign and date
You, and your spouse if filing jointly, must sign and date your return. If you are filing for a minor as a parent or guardian, you must sign and date the return.
If you do not sign your return,
- it will be considered not filed and you may be subject to a nonfiler penalty.
- and three years have passed since the extended due date of that return, any overpayment will be forfeited.
Attach: Staple all required copies of forms and schedules, powers of attorney, and letters of estate or office to the tax return.
Paid preparer
If you pay someone to prepare your return, the paid preparer must also sign and date your return, provide a phone number, and enter their Preparer Tax Identification Number (PTIN) issued by the IRS.
Check the box if the paid preparer is self-employed. If the paid preparer is employed with a professional tax preparation firm, the paid preparer also must provide the name, the Federal Employer Identification Number (FEIN), the address, and phone number of the firm.
Third party designee (optional)
If you want to allow another person to discuss this return and any previous return that affects the liability reported on this return with us, check the box and print the designee’s name and telephone number. The authorization will allow your designee to answer any questions that arise during the processing of your return, call us with questions about your return, and receive or respond to notices we send. You may revoke the authorization at any time by calling or writing us.