Advanced Premium Tax Credit Attestation

I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents:

• If any of the information I have provided in my application changes, I understand it may change my ability to get the tax credit.
• I must file a federal income tax return in 2016 for the tax year 2017.
• If I am married at the end of 2017, I must file a joint federal income tax return with my spouse.
• No one else will be able to claim me as a dependent on their 2017 federal income tax return.
• I will claim a personal exemption deduction on my 2017 federal tax return for any individual listed on this application as a dependent who is enrolled in health coverage through this Health Insurance Marketplace and whose monthly premium for coverage is paid for in who or in part by tax credits.
• I understand that when I file my 2017 federal tax return, the Internal Revenue Service (IRS) will compare the income on my federal tax return with the income on this application.
• I understand that if the income on my federal tax return is lower than the income on this application, I may be eligible to get an additional tax credit.
• I understand that if the income on my federal tax return is higher than the income on this application, I may owe additional federal income taxes.