Internal Revenue Service United States Department of the Treasury
Level Basic Advanced Military International

Affordable Care Act Workout

Workout Resources

Intake/Interview & Quality Review Sheet

While conducting an interview with taxpayers using Form 13614-C, Intake/Interview & Quality Review Sheet, you will determine whether taxpayers, their spouse (if filing a joint return), and their dependents had MEC for the entire year, part of the year, or not at all.

Taxpayers may have insurance cards or receive Forms 1095-A, 1095-B, or 1095-C from the Marketplace, their insurance provider, or employer. These forms may indicate the taxpayer or a member of the tax household had MEC for some or all months during the year, but volunteers should rely primarily on their interview with the taxpayer. While the information on these forms may assist in preparing a return, it is not necessary to wait for Forms 1095-B or 1095-C in order to file.


Be sure to complete the ACA preparer section of Form 13614-C, Intake/Interview & Quality Review Sheet. Note MEC and coverage exemptions as applicable for the taxpayer, spouse, and dependents.

Form 13614C Intake Interview Sheet showing health care coverage.