IRS Form 14765 – IRS Forms, Instructions, Pubs 2026 – In the complex landscape of the Affordable Care Act (ACA), Applicable Large Employers (ALEs) must navigate various reporting requirements and potential penalties. One key document in this process is IRS Form 14765, also known as the Employee Premium Tax Credit (PTC) Listing. This form plays a crucial role in the Employer Shared Responsibility Payment (ESRP) assessment under Internal Revenue Code (IRC) Section 4980H. If you’re an employer who has received Letter 226-J from the IRS, understanding Form 14765 is essential for compliance and potentially reducing or eliminating proposed penalties.
This SEO-optimized guide covers everything you need to know about IRS Form 14765, including its purpose, contents, how to respond, and related compliance tips. Whether you’re dealing with ACA employer mandates or seeking to avoid ESRP liabilities, read on for actionable insights based on official IRS resources.
What Is IRS Form 14765?
IRS Form 14765 is a listing provided by the IRS to ALEs—employers with 50 or more full-time employees (including full-time equivalents)—as part of the ESRP proposal process. Unlike forms that employers file, such as Form 1095-C, Form 14765 is generated by the IRS based on data from your submitted ACA information returns and employee premium tax credit claims.
The form identifies “assessable full-time employees,” which are individuals who:
- Were full-time employees for at least one month in the tax year.
- Received a premium tax credit (PTC) for purchasing health coverage through a Health Insurance Marketplace.
- Did not qualify for an affordability safe harbor or other relief as reported on their Form 1095-C (specifically lines 14 and 16).
Revised in May 2021, the form is available for download from the IRS website and is typically enclosed with IRS Letter 226-J, which notifies employers of a potential ESRP.
Purpose of the Employee Premium Tax Credit (PTC) Listing
The primary purpose of Form 14765 is to support the IRS’s calculation of an ESRP, also known as the “employer mandate penalty.” Under the ACA, ALEs must offer minimum essential coverage (MEC) that is affordable and provides minimum value to at least 95% of their full-time employees and dependents. If they fail to do so and at least one full-time employee receives a PTC, the employer may be liable for payments under IRC 4980H(a) or 4980H(b).
Form 14765 lists employees who trigger this potential liability, allowing employers to review and contest the IRS’s determinations. It highlights months where no safe harbor or relief applies, helping employers identify inaccuracies in their original reporting. Employers can use this form to make corrections without filing amended returns, potentially reducing the proposed ESRP amount.
Key Components of IRS Form 14765
Understanding the structure of Form 14765 is vital for accurate review. Here’s a breakdown of its main elements:
- Employer Information: Includes the employer’s name, Employer Identification Number (EIN), and the relevant tax year.
- Employee Details: For each listed employee, the form shows their last name, first name, and the last four digits of their Social Security Number (SSN).
- Monthly Grid: A 12-column table (January to December) with indicator codes from Form 1095-C lines 14 (offer of coverage) and 16 (safe harbors/relief). Codes are combined (e.g., 1H/2A).
- All 12 Months Column: For uniform codes across the year.
- Highlighting and Notes:
- Non-highlighted months: The employee received a PTC, no relief applied, and they are considered assessable.
- Highlighted months: The employee is not assessable.
- Special codes like XF, XG, or XH: Indicate the IRS determined the claimed safe harbor (2F, 2G, or 2H) does not apply. Employers can challenge this with computations in a reconsideration request.
- Additional Information: Space for attached details or notes.
| Component | Description | Relevance to ESRP |
|---|---|---|
| Employer Name & EIN | Identifies the ALE | Ensures the form applies to your business |
| Employee Name & SSN (Last 4 Digits) | Lists potentially assessable employees | Allows verification against your records |
| Indicator Codes | From Form 1095-C (Lines 14 & 16) | Determines eligibility for safe harbors like affordability or transition relief |
| Monthly Highlighting | Shows assessable vs. non-assessable months | Directly impacts penalty calculations |
How Employers Receive and Respond to Form 14765?
Employers do not file Form 14765 proactively; it arrives via IRS Letter 226-J, which includes:
- An ESRP Summary Table outlining monthly calculations.
- Form 14764 (ESRP Response).
- The PTC Listing (Form 14765).
Response Process
You have 30 days from the letter date to respond. Here’s how:
- Review Documents: Compare the PTC Listing with your Forms 1094-C and 1095-C.
- If You Agree: Sign Form 14764, include payment (if any), and mail it back. Use EFTPS for electronic payments.
- If You Disagree:
- Complete Form 14764.
- Provide a signed statement explaining disputes.
- Make changes directly on Form 14765’s second row for each month using valid indicator codes (refer to Instructions for Forms 1094-C and 1095-C).
- Attach supporting documentation (e.g., affordability calculations).
- Do not file corrected Forms 1095-C; changes are for this response only.
- Submit: Mail to the address in the letter. The IRS will review and issue a Letter 227 series response, which may include an updated Form 14765.
- Appeals: If still disagreeing after Letter 227, request a pre-assessment conference with IRS Appeals.
Failure to respond results in assessment of the proposed ESRP via Notice CP 220J, leading to collection actions like liens or levies.
Penalties and Compliance Tips for ESRP
The ESRP is calculated monthly and is not tax-deductible. Amounts vary based on:
- 4980H(a): No offer to 95% of full-time employees—penalty on all full-time employees minus allowances.
- 4980H(b): Offer made but unaffordable—penalty per assessable employee receiving PTC.
To avoid or minimize penalties:
- Ensure accurate ACA reporting on Forms 1094-C and 1095-C.
- Use safe harbors (e.g., federal poverty line, W-2, rate of pay) for affordability.
- Offer MEC to full-time employees and dependents.
- Retain records for at least three years.
- Consult a tax professional for complex cases.
Frequently Asked Questions About IRS Form 14765
1. Who Must Respond to Form 14765?
Only ALEs receiving Letter 226-J. Small employers (under 50 full-time employees) are exempt from ESRP.
2. Can I File Form 14765 Electronically?
No, responses are mailed. However, original ACA forms are filed electronically if over 250 returns.
3. What If the IRS Disqualifies My Safe Harbor (e.g., Code XF)?
Provide computations showing why it applies in your response or reconsideration request.
4. Is There a Deadline Extension?
Contact the IRS employee listed in Letter 226-J for possible extensions.
5. Where Can I Download Form 14765?
From the official IRS website: https://www.irs.gov/pub/irs-pdf/f14765.pdf.
Conclusion
Navigating IRS Form 14765 and the ESRP process requires careful review and timely action to ensure ACA compliance. By understanding the form’s role in identifying assessable employees and responding effectively, employers can mitigate penalties and maintain good standing with the IRS. For the most current guidance, always refer to official IRS resources or consult a qualified advisor.
This article is based on IRS publications as of February 2026. Tax laws can change, so verify with the latest updates on IRS.gov.