If you are currently enrolled in the HCTC AMP program and you changed/updated your mailing address with BCBSM, you MUST verify that your address matches what the IRS currently has. If the address is different, you MUST submit a new 13441-A form to the IRS. The form must be completely filled out and mailed to the IRS. (Visit our website at www.dsrabenefittrust.net or download the form at https://www.irs.gov/pub/irs-pdf/f13441a.pdf.)

Sample of IRS Form13441-A for various situations can be found at the following link: https://www.dsrabenefittrust.net/dsrabene/index.php/document-center/Health-Coverage-Tax-Credit-(HCTC)/Sample-Documents/.

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DSRA-Benefit Trust Board of Directors


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