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Official form guide
Form 13560: Health Plan Administrator (HPA) Return of Funds
Treasury Department Form 13560 is a Health Plan Administrator (HPA) Return of Funds form used for returning the Government’s portion of an insurance premium; it must accompany all returned funds.
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IRS Form 13560 - Health Plan Administrator (HPA) Return of Funds
Treasury Department Form 13560 is a Health Plan Administrator (HPA) Return of Funds form used for returning the Government’s portion of an insurance premium; it must accompany all returned funds.
Risk Radar
Scan points- 1The participant's portion of the insurance premium must be returned directly to the participant.
- 2Filing only the HPA check without completing Form 13560.
- 3Returning the participant's portion of the premium via this form instead of directly to the participant.
- 4Omitting a detailed listing when more than one participant is impacted by the return.
- 5Not including the last four digits of the insured's social security number on the Insured section.
Plain English
This form lets you send back money that the government paid toward someone's health insurance. It ensures that the correct amount is credited back to the right person or program. The participant's share of the payment must be sent directly to the participant, not via this form.
Submission Date
- Filing date: 2017-09-16 07:59:18
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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What this form is for
- Use this form when returning the Government’s portion of an insurance premium from your health plan to the HCTC Program.
- Do not use this form when only returning the participant’s portion of the insurance premium; that amount must be returned directly to the participant.
- Check Form 13560 instead when you are submitting a bulk payment and need to detail how it should be allocated.
Form selector
Use this form or another form?
Returning funds for multiple individuals via one check
The detailed list must contain all required HPA Return of Funds information for each person.
✓ Check the attached list against this form's requirements.
Reversing an Electronic Fund Transfer (EFT) transaction
This requires notifying your bank to reject and reverse the original payment back to the US Department of Treasury.
✓ Ensure the notification references Form 13560.
Returning an uncashed US Treasury check
When mailing a physical, uncashed US Treasury check, this form must accompany it for proper handling.
✓ Verify you are mailing the check to the Beckley Finance Center.
Deadline or filing window
The official source does not list a specific filing deadline date. However, this form MUST accompany all returned funds immediately to ensure proper handling by the Internal Revenue Service. There is no mention of an extension period in the provided excerpt.
Checklist
What you need before filling it out
Insured Name
Name of the insured individual · Insured section
SSN (last 4 digits)
Last four digits of the participant's social security number · Insured section
Participant's PIN
The specific Personal Identification Number for the participant · Detailed listing section
Total Amount Returned
The total monetary value being returned for that individual · Insured section / Detail List
Reason for termination
The specific reason why coverage ended · Insured section / Detail List
Return Method Check
HPA check, EFT reversal notification, or uncashed check · Top of form (implied by options)
Before you submit
- 1Verify that the form is dated May 2017 (Rev. 5-2017).
- 2Ensure you are returning ONLY the Government’s portion of the insurance premium.
- 3If multiple participants are listed, include a detailed listing for every individual.
- 4When filling out the Insured section, provide only the last four digits of the insured's SSN.
- 5If sending an HPA check, make it payable to 'US Treasury - HCTC'.
- 6If filing via mail, confirm the address is Beckley Finance Center, PO Box 9002, Beckley WV 25802-9002.
- 7Attach this completed Form 13560 with your returned funds.
How to file this form
- 1Complete the HPA Return of Funds form by filling in required details for each participant, including Insured Name and last 4 digits of SSN.
- 2If returning multiple individuals, ensure a detailed listing accompanies one check (or use separate forms) containing all necessary data points.
- 3Select the applicable return option: either send an HPA check, notify your bank to reverse an EFT, or submit an uncashed US Treasury check.
- 4Mail the completed Form 13560 along with the funds to the Internal Revenue Service Beckley Finance Center at PO Box 9002, Beckley WV 25802-9002, and keep a copy for your records.
Known limitations
- 1Form 13560 is specifically for returning the Government’s portion of the insurance premium; the participant’s portion must be returned directly to the participant.
- 2If an organization uses a similar internal document that provides all requested information, submitting that document in lieu of Form 13560 is acceptable.
- 3When completing the Insured section, only the last four digits of the insured's social security number must be filled in.
Field map
Compact field-by-field guide
General Info
2 items
Full legal name and taxpayer identification number (SSN or EIN).
Current mailing address.
Details
2 items
Complete all applicable sections of this form according to the official IRS instructions.
Enter the relevant dollar amount if this form involves tax calculation.
Certification
1 items
Read and acknowledge any certifications required by this form.
Signatures
1 items
Sign and date. Unsigned forms cannot be processed.
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Fillable formOpen in Editor->The current edition is May 2017 (Rev. 5-2017). The source does not indicate a specific 'latest information' page, but it provides the revision date and catalog number for verification.
What changed or needs a fresh check
- Edition date — confirm May 2017 (Rev. 5-2017)
- Catalog Number — confirm 38302P
- OMB Number — confirm 1545-1891
- Mailing Address — confirm Internal Revenue Service Beckley Finance Center, PO Box 9002, Beckley WV 25802-9002
- Fax Number (for EFT reversal) — confirm 855-780-9044
Quick Facts
Downloads
After you file
- 1Keep a copy of the completed Form 13560.
- 2The information provided on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210, which involves transmitting payment data electronically to vendor’s financial institution.
- 3Failure to provide the requested information on Form 13560 may delay or prevent the receipt of payments through the Automated Clearing House Payment System.
- 4If returning funds for multiple individuals using one check, a detailed list defining how the bulk payment should be allocated must be attached.
Sources
- SRCForm 13560 is a Health Plan Administrator (HPA) Return of Funds form from the Department of the Treasury - Internal Revenue Service (Rev. 5-2017, May 2017).
- SRCThe purpose of Form 13560 is for returning the Government’s portion of the insurance premium ONLY.
- SRCWhen completing the Insured section on Form 13560, fill in the last four digits of the insured's social security number.
- SRCIf more than one participant is impacted by the return of the Government's Portion, a detail listing must be included.
- SRCTo send an HPA check, it must be made payable to US Treasury - HCTC and mailed to Internal Revenue Service Beckley Finance Center PO Box 9002, Beckley WV 25802-9002.
- SRCFor a bulk payment return, the detailed list must include Insured Name, SSN (last 4 digits), Date Coverage Ended, Reason for Termination, Total Amount Returned, and Reason for Returned Funds.
Common confusion points
What if I have multiple participants whose funds are being returned?
A detail listing of all participants is required.
→ Ensure this list includes Insured Names, last 4 digits of SSN, Participant's PIN, Date Coverage Ended, Reason for termination, total amount returned, and reason for returned funds.
How do I return the money if I am sending a check?
Send an HPA check payable to US Treasury - HCTC.
→ Mail this form attached to the check to the Internal Revenue Service Beckley Finance Center at PO Box 9002, Beckley WV 25802-9002.
What if I need to reverse an electronic fund transfer (EFT)?
Notify your bank that you wish to reject the EFT and request a reversal back to the US Department of Treasury.
→ Complete Form 13560 and FAX it to the Internal Revenue Service at 855-780-9044.
Can I return an uncashed check?
Yes, you can mail this form attached to the check.
→ Mail the completed Form 13560 and the check to the Internal Revenue Service Beckley Finance Center at PO Box 9002, Beckley WV 25802-9002.
If I return funds for multiple people using one check, what must be attached?
A detailed list defining how the bulk payment should be allocated.
→ Verify this list includes all required information (listed below) for each individual.
Workflow map
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- Not stated in the official source — verify on the agency site
Questions about IRS Form 13560
What is IRS Form 13560 used for?
This form lets you send back money that the government paid toward someone's health insurance. It ensures that the correct amount is credited back to the right person or program. The participant's share of the payment must be sent directly to the participant, not via this form.
Who must file IRS Form 13560?
A Health Plan Administrator (HPA) files Form 13560 when returning the Government’s portion of an insurance premium.
What information does IRS Form 13560 require?
The form collects details about the insured person, including their name and the last four digits of their social security number. If multiple participants are involved, a detail listing must include Participant's PIN, Date Coverage Ended, Reason for termination, total amount returned, and reason for returned funds.
Where do I file IRS Form 13560?
Funds can be mailed to the Internal Revenue Service Beckley Finance Center at PO Box 9002, Beckley WV 25802-9002. Alternatively, if reversing an EFT transaction, the form can be FAXed to the IRS HCTC at 855-780-9044.
How do I complete IRS Form 13560?
First, complete the HPA Return of Funds form with all required details. If returning funds for multiple individuals, a detailed listing is necessary alongside the main form(s). Finally, attach this completed Form 13560 to your payment before mailing or faxing it in.
What happens if IRS Form 13560 is filed incorrectly?
Failure to provide requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. The document must accompany all returned funds for proper handling.
What if I have multiple participants whose funds are being returned?
A detail listing of all participants is required. Ensure this list includes Insured Names, last 4 digits of SSN, Participant's PIN, Date Coverage Ended, Reason for termination, total amount returned, and reason for returned funds.
How do I return the money if I am sending a check?
Send an HPA check payable to US Treasury - HCTC. Mail this form attached to the check to the Internal Revenue Service Beckley Finance Center at PO Box 9002, Beckley WV 25802-9002.
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