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Form 13973: Health Coverage Tax Credit (HCTC) Blank Payment Coupon
Treasury–Internal Revenue Service Form 13973 is a Health Coverage Tax Credit (HCTC) Blank Payment Coupon used to remit payment for the HCTC Program. This form has an OMB Number of 1545-1891 and was revised in November 2016.
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IRS Form 13973 - Health Coverage Tax Credit (HCTC) Blank Payment Coupon
Treasury–Internal Revenue Service Form 13973 is a Health Coverage Tax Credit (HCTC) Blank Payment Coupon used to remit payment for the HCTC Program. This form has an OMB Number of 1545-1891 and was revised in November 2016.
Risk Radar
Scan points- 1Do not write below the designated line on the payment coupon.
- 2Failing to re-enter the correct HCTC Participant Identification Number on Form 13973.
- 3Making the check payable to an incorrect entity (must be US Treasury – HCTC).
- 4Not writing the HCTC Participant Identification Number on the payment check itself.
- 5Sending cash instead of using one of the accepted mail payment methods.
Plain English
This coupon allows someone who enrolled in the Health Coverage Tax Credit (HCTC) Program to submit a payment directly to the IRS. By completing this form, you are sending in the money owed for your HCTC credit claim. Electronic completion helps ensure the payment is processed quickly and accurately.
Submission Date
- Filing date: 2016-11-10 00:00:00
- Preparation window: collect IDs, supporting records, and signatures in advance.
- Final review: verify names, dates, and required fields before submission.
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Glossary Terms
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What this form is for
- Use this form when you received an IRS notification letter stating successful enrollment in the HCTC Program.
- Do not use this form when you have not yet received a notification letter from the IRS regarding your HCTC enrollment.
- Check Form 13973 itself instead when completing the payment coupon.
Form selector
Use this form or another form?
Paying via electronic means
Electronic completion assists with accurate and timely processing of payment
✓ Verify on IRS website for specific e-filing instructions
Needing to pay by cash
The coupon specifies, 'Do not send cash,' so a different method is required.
✓ Confirm the designated payment methods listed in Step 4.
Paying outside of St. Louis, MO
All payments must be sent to US Treasury – HCTC P.O. Box 970023, St. Louis, MO 63197-0023.
✓ Ensure the full mailing address is correctly transcribed.
Deadline or filing window
The HCTC Program accepts payments upon receipt; post-dated checks will not be held for a later deposit. The form does not specify a filing deadline, but it must accompany your payment when you are required to submit it.
Checklist
What you need before filling it out
HCTC Participant Identification Number
Your number from enrollment letter · Top of enrollment notification letter
Amount Paid
The specific dollar amount you are paying · Space provided on the coupon (e.g., $ , .)
Payment Method
Personal, business, certified, cashier's check, or money order · Section 4 details
Check Payable To
US Treasury – HCTC · Payment Details section
Required Information Provided
Participant Name, Address (Street, City, State, Zip), Amount Paid · Step 1 fields
Before you submit
- 1Complete all spaces requested in Step 1 before printing.
- 2Ensure the HCTC Participant Identification Number is correctly re-entered on the coupon.
- 3Verify that your payment check is made payable to US Treasury – HCTC.
- 4Confirm you have written your HCTC Participant Identification Number on the payment check.
- 5Check that all required address fields (Street, City, State, Zip) are filled out.
- 6Ensure the coupon itself is cut off precisely where indicated below the details.
- 7Verify that the amount paid matches the dollar amount you are sending.
How to file this form
- 1Complete Step 1 by filling in your HCTC Participant Identification Number, Name, Address, and Amount Paid directly on Form 13973.
- 2Print the document (Step 2) and cut off the payment coupon where indicated below the details (Step 3).
- 3Prepare your payment using an accepted method (check or money order), making it payable to US Treasury – HCTC, and write your HCTC Participant Identification Number on the check.
- 4Send the cut-off payment coupon along with your payment to US Treasury – HCTC at P.O. Box 970023 in St. Louis, MO 63197-0023 (Step 4).
Known limitations
- 1This coupon must be used if a notification letter from the IRS states the filer has successfully enrolled in the HCTC Program.
- 2The payment coupon must be cut off where indicated before being sent with the payment.
- 3Cash payments are not accepted on this form; do not send cash.
- 4The coupon should not be folded, stapled, or paper clipped when sending it.
Field map
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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 November 2016. The source does not point to a separate 'latest information' page but provides the revision date directly on Form 13973.
What changed or needs a fresh check
- Edition date — confirm November 2016
- OMB Number — confirm 1545-1891
- Mailing address — confirm US Treasury – HCTC P.O. Box 970023, St. Louis, MO 63197-0023
- Signature — Not stated in the official source (signing is implied by completing and sending)
- Payment payable to — confirm US Treasury – HCTC
Quick Facts
Downloads
After you file
- 1Retain a copy of the completed Form 13973 for records.
- 2Ensure the payment is made payable to US Treasury – HCTC.
- 3Write the HCTC Participant Identification Number on the check provided as payment.
- 4The IRS will process checks upon receipt, but post-dated checks will not be held for a later deposit.
Sources
- SRCInstructions p.1 — The HCTC payment coupon is used if a notification letter from the IRS states successful enrollment.
- SRCInstructions p.1 — The HCTC Participant Identification Number can be found at the top of the enrollment notification letter.
- SRCInstructions p.1 — Step 1 requires completing fields like Participant Name, Street Address, City, State and Zip, Amount Paid, and re-entering the HCTC Participant Identification Number.
- SRCInstructions p.1 — After printing (Step 2), the coupon must be cut off where indicated (Step 3) and sent with payment to US TreasuryHCTC, P.O. Box 970023, St. Louis, MO 63197-0023 (Step 4).
- SRCInstructions p.1 — Accepted payment methods are personal check, business check, certified check, cashier's check, and money order.
- SRCInstructions p.1 — The form has an OMB Number of 1545-1891 and is dated November 2016 (Rev.).
Common confusion points
Where do I find my HCTC Participant Identification Number?
The form requires this number to link the payment to your account.
→ Look for it on the top of your enrollment notification letter.
What should I do if you don't have a physical coupon?
Electronic completion is available and assists with timely processing.
→ Complete Step 1 electronically before printing, or complete the fields directly on the PDF.
What if I don't know where to send this?
The mailing address is specific for HCTC payments.
→ Send it to US Treasury – HCTC, P.O. Box 970023, St. Louis, MO 63197-0023.
What payment methods are accepted?
The form lists specific acceptable ways to pay by mail.
→ Acceptable methods include personal check, business check, certified check, cashier's check, and money order.
Do I need to write anything below the payment coupon line?
The instructions specify where the cut-off point is.
→ Do not write anything below the line that reads: 'Please do not write below this line.'
What if I forget to fill out one field?
Failure to provide all required information can delay processing.
→ Double-check every field before printing and mailing the Form 13973.
Workflow map
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⚠ If something goes wrong
- Not stated in the official source — verify on the agency site (Contacting the Tax Products Coordinating Committee is suggested for accuracy concerns).
Questions about IRS Form 13973
What is IRS Form 13973 used for?
This coupon allows someone who enrolled in the Health Coverage Tax Credit (HCTC) Program to submit a payment directly to the IRS. By completing this form, you are sending in the money owed for your HCTC credit claim. Electronic completion helps ensure the payment is processed quickly and accurately.
Who must file IRS Form 13973?
This coupon should be used by any individual who received an IRS notification letter stating they successfully enrolled in the HCTC Program.
What information does IRS Form 13973 require?
The form collects identifying information such as the HCTC Participant Identification Number, the participant's Name, Street Address, City, State and Zip, and the specific Amount Paid. These details are used to process the payment transaction.
When is IRS Form 13973 due?
The official source does not state a specific due date; rather, it dictates that the coupon should be sent along with the payment when required by the HCTC Program.
Where do I file IRS Form 13973?
Payment coupons must be sent to US Treasury – HCTC at P.O. Box 970023 in St. Louis, MO 63197-0023. The form also allows for electronic completion which assists with timely processing.
How do I complete IRS Form 13973?
First, complete Step 1 by filling in the requested spaces, ideally after auto-populating using your HCTC Participant Identification Number. Next, print the document (Step 2), cut off the payment coupon where indicated (Step 3), and finally, send it with your payment to the specified address (Step 4).
What happens if IRS Form 13973 is filed incorrectly?
Failure to provide all required information on Form 13973 could delay the processing of your payment through the HCTC Program.
Where do I find my HCTC Participant Identification Number?
The form requires this number to link the payment to your account. Look for it on the top of your enrollment notification letter.
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