Pennsylvania Wrongful Death/Survival Action Request

Wrongful Death/Survival Action Request
Wrongful Death/Survival Action Request - MCARE Settlements and Nonresident Decedent Settlements (REV-1517)Wrongful Death/Survival Action Request
REV-1517 (EX) MOD 01-20

MCARE Settlements and Nonresident Decedent Settlements

IMPORTANT INFORMATION FOR FIRMS REQUESTING
A WRONGFUL DEATH/SURVIVAL ACTION APPROVAL
LETTER FROM THE PENNSYLVANIA DEPARTMENT OF
REVENUE THAT INCLUDES PAYMENT FROM THE
MEDICAL CARE AVAILABILITY AND REDUCTION OF
ERROR FUND (MCARE) OR FOR A NONRESIDENT
DECEDENT

The following information should be supplied with each
request so that the request can be reviewed in a timely
manner:

The department will make every effort to process the
MCARE settlements or settlements for a nonresident
decedent in an expedited manner provided the following
conditions are met:

● If letters testamentary were granted, a copy of the
will.

● If the petition is being filed through regular mail, attach
a copy of this document to the top of the petition.

3. Information that will help support the allocation you are
requesting.

PA DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
ATTN: WRONGFUL DEATH/SURVIVAL
ACTION REQUEST
PO BOX 280600
HARRISBURG PA 17128-0600
● If
the
petition
is
being
emailed
to
[email protected], the subject line must
state “MCARE Settlement” or “Nonresident Decedent”.

1. A copy of the petition.
2. A copy of the letters granted by the Register of Wills
office.

● If letters of administration were granted, a listing of
the intestate heirs.

● Information on age, work history, educational
history, economic study, and pecuniary loss
suffered by wrongful death claimants.
NOTE: Item 3 is not required for a nonresident decedent.
If you have any questions, please contact this office directly
at 717-787-8327.
For additional information regarding wrongful death/survival
action settlements, see form REV-1518.

● If the petition is being faxed to 717-783-3467, attach a
copy of this document to the top of the petition before
the cover sheet.

www.revenue.pa.gov

REV-1517

Extracted from PDF file 2023-pennsylvania-rev-1517-instructions.pdf, last modified January 2020

Download This Form

Print This Form

More about the Pennsylvania REV-1517 (Instructions) Individual Income Tax TY 2023

Instructions for the Wrongful Death/Survival Action Approval Letter

We last updated the Wrongful Death/Survival Action Request in February 2024, so this is the latest version of REV-1517 (Instructions), fully updated for tax year 2023. You can download or print current or past-year PDFs of REV-1517 (Instructions) directly from TaxFormFinder. You can print other Pennsylvania tax forms here.

Other Pennsylvania Individual Income Tax Forms:

TaxFormFinder has an additional 174 Pennsylvania income tax forms that you may need, plus all federal income tax forms.

Form Code	Form Name
Form PA-40	Pennsylvania Income Tax Return Tax Return
Form 40 Instruction Booklet	Income Tax Return Instruction Booklet (PA-40)
Form PA-40 SP	PA Schedule SP - Special Tax Forgiveness Tax Credit
Form PA-40 A	PA Schedule A - Interest Income
Form PA-40 PA-V	PA-40 Payment Voucher Voucher

Download all PA tax forms View all 175 Pennsylvania Income Tax Forms

Form Sources:

Pennsylvania usually releases forms for the current tax year between January and April. We last updated Pennsylvania REV-1517 (Instructions) from the Department of Revenue in February 2024.

Show Sources >

About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Pennsylvania REV-1517 (Instructions)

We have a total of two past-year versions of REV-1517 (Instructions) in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2023 REV-1517 (Instructions)

Wrongful Death/Survival Action Request - MCARE Settlements and Nonresident Decedent Settlements (REV-1517)

2022 REV-1517 (Instructions)

Wrongful Death/Survival Action Request - MCARE Settlements and Nonresident Decedent Settlements (REV-1517)

TaxFormFinder Disclaimer:

While we do our best to keep our list of Pennsylvania Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.