Arizona Credit for Qualified Health Insurance Plans

Credit for Qualified Health Insurance Plans
Arizona Form 347
Arizona Form

347

2017

Credit for Qualified Health Insurance Plans

Include with your return.
For the calendar year 2017 or fiscal year beginning M M D D 2 0 1 7 and ending M M D D Y Y Y Y .
Your Name as shown on Form 140, 140PY, 140NR, 140X, 99T, 120, 120A, 120S, 120X or 165

Your Social Security or Employer Identification Number

Spouse’s Name as shown on Form 140, 140PY, 140NR, 140X (if a joint return)

Spouse’s Social Security Number

Total Available Credit Carryover
(a)
Taxable Year from
which you are
carrying a credit

	 1

2014

(b)
Original Credit Amount

(c)
Amount Previously Used

(d)
Available Carryover:
Subtract column (c) from
column (b).

00

00

00

Print 347

Instructions
For information or help, call one of the numbers listed:
(602) 255-3381
Phoenix	
From area codes 520 and 928, toll-free	
(800) 352-4090
Tax forms, instructions, and other tax information
If you need tax forms, instructions, and other tax information,
go to the department’s website at www.azdor.gov.
Income Tax Procedures and Rulings
These instructions may refer to the department’s income tax
procedures and rulings for more information. To view or print
these, go to our website and click on Legal Research then click
on Procedures or Rulings and select a tax type from the drop
down menu.
Publications
To view or print the department’s publications, go to our
website and click on Publications.

General Instructions
Individuals: You must also complete Arizona Form 301,
Nonrefundable Individual Tax Credits and Recapture, and
include Forms 301 and 347 with your tax return to claim this
credit.
Corporate taxpayers including exempt organizations with
unrelated business taxable income: You must also complete
Arizona Form 300, Nonrefundable Corporate Tax Credits and
Recapture, and include Forms 300 and 347 with your tax return
to claim this credit.
The credit for qualified health insurance plans was repealed
effective for taxable years beginning from and after December 31,
2014. Taxpayers cannot claim any new credits.
ADOR 11177 (17)

If the credit was claimed in taxable year 2014, and the amount
of credit was more than your tax liability or if you had no tax, the
unused credit may be carried forward for the next three consecutive
tax years.

Line-by-Line Instructions

Enter your name and Social Security Number (SSN) as shown on
Arizona Forms 140, 140PY, 140NR, or 140X.
All returns, statements, and other documents filed with the
department require a taxpayer identification number (TIN). The
TIN for an individual is the taxpayer’s SSN or an Internal Revenue
Service (IRS) individual taxpayer identification number (ITIN).
Taxpayers who fail to include their identification number may be
subject to a penalty.

Total Available Credit Carryover
If you claimed the credit on your 2014 return, and the credit was
more than your tax.
•	In column (b), enter the credit originally computed for the
taxable year listed in column (a).
•	 In column (c), enter the amount of the credit from that taxable
year which you have already used.
•	 In column (d), subtract the amount in column (c) from the
amount in column (b) and enter the difference.
Individuals: Enter the amount in column (d) on Arizona Form 301,
Part 1, line 28, columns (b) and (c).
Corporations, including S corporations claiming the credit and
exempt organizations with UBTI: Enter the amount in column
(d) on Arizona Form 300, Part 1, line 22, columns (b) and (c).