Printable Form 2026

IRS Form 8453-R – Electronic Filing Declaration for Form 8963

IRS Form 8453-R  – Health insurance providers and covered entities required to report under the Affordable Care Act (ACA) once used IRS Form 8453-R as a critical authentication document for electronic submissions. This form serves as the official electronic filing declaration specifically for Form 8963 (Report of Health Insurance Provider Information).

Whether you’re a tax professional, compliance officer, or organization navigating ACA reporting requirements, understanding Form 8453-R ensures proper electronic filing procedures. This comprehensive guide draws directly from official IRS sources, including the current Form 8453-R (Rev. January 2020) and related instructions.

What Is IRS Form 8453-R?

IRS Form 8453-R, titled Electronic Filing Declaration for Form 8963, authenticates the electronic transmission of Form 8963 to the IRS.

The IRS requires this declaration because electronically filed reports lack a traditional wet signature. Form 8453-R provides the signed officer declaration under penalties of perjury, confirming the accuracy and completeness of the submitted data.

The form applies to calendar year filings (indicated as “For calendar year 20__” on the document) and was primarily relevant for the 2020 fee year reporting.

Purpose of Form 8453-R

The form serves one primary purpose:

“Use Form 8453-R to authenticate the electronic filing of Form 8963, Report of Health Insurance Provider Information.”

Without a properly signed and uploaded Form 8453-R, the IRS does not consider an electronic Form 8963 complete or filed. The declaration allows the IRS to:

  • Acknowledge receipt of the electronic report
  • Communicate processing delays or issues directly with the transmitter
  • Hold the signing officer accountable under penalties of perjury

Who Must File Form 8453-R?

You must file Form 8453-R if you submit Form 8963 electronically. This includes:

  • Health insurance issuers and providers reporting net premiums written for U.S. health risks
  • Designated entities filing on behalf of a controlled group or affiliated group
  • Any covered entity required (or choosing) to e-file Form 8963

Electronic filing is mandatory for organizations reporting more than $25 million in net premiums written (per 26 C.F.R. section 57.3). Smaller filers may choose paper filing and skip Form 8453-R.

The signing officer must be:

  • President, vice president, treasurer, assistant treasurer, or chief accounting officer, or
  • Any other duly authorized officer of the single-person covered entity or designated entity

How to File Form 8453-R (Step-by-Step)?

  1. Complete Form 8963 first (report net premiums written).
  2. Print or fill the official Form 8453-R (use the fillable PDF from IRS.gov).
  3. Have an authorized officer manually sign and date the declaration section.
  4. Scan the signed form into a high-quality PDF file.
  5. Upload the PDF together with the electronic Form 8963 submission via IRS e-file.
  6. Retain a copy for your records.

Important note from IRS instructions: Do not print and scan a filled electronic version of Form 8963 itself—upload the fillable version and attach the scanned 8453-R.

Alternative for 2020 only (per 2020 instructions): Certain filers could fax Form 8963 to 877-797-0235, but Form 8453-R was still required for full electronic authentication.

Key Declaration Language (Excerpt from Form 8453-R)

The officer signs under penalties of perjury, declaring:

“I declare that I have examined the electronic report, including accompanying statements, and, to the best of my knowledge and belief, it is true, correct, and complete… Each person that is a controlled group member at the end of the day on December 31, 2019, is jointly and severally liable for this fee.”

The form also confirms consent to the designated entity and joint liability for any penalties.

Form 8963 and the ACA Health Insurance Provider Fee (Section 9010)

Form 8963 collected data on net premiums written to calculate the annual fee imposed on health insurance providers under ACA Section 9010. Covered entities reported this information annually, typically by April 15 of the fee year.

Major Update – Fee Repealed
The Further Consolidated Appropriations Act, 2020, repealed the annual fee for calendar years beginning after December 31, 2020 (i.e., 2021 fee year and beyond).

As a result:

  • No new Form 8963 filings are required for fee years after 2020.
  • Form 8453-R is no longer needed for current-year submissions.
  • The 2020 version remains available on IRS.gov for historical reference, record-keeping, or amended prior-year filings.

The IRS explicitly marks the Form 8963 “About” page as historical and no longer updated.

Paperwork Reduction Act and Time Estimates (From Official Form)

  • Recordkeeping: 1 hr., 12 min.
  • Learning about the form: 12 min.
  • Preparing and sending: 13 min.

Comments on form burden can be submitted via IRS.gov/FormComments.

Where to Download Official Documents?

Always use the official IRS website for the most authoritative versions—never rely on third-party copies for filing.

Frequently Asked Questions (FAQs)

Is Form 8453-R still required in 2025 or 2026?
No. Due to the repeal of the health insurance provider fee, neither Form 8963 nor Form 8453-R is required for current filings.

Can I e-file Form 8963 without Form 8453-R?
No—the electronic report is not considered filed without the properly signed and uploaded declaration.

Who signs Form 8453-R?
An authorized officer of the covered entity or designated entity. The signature must be manual (wet ink) before scanning.

Is there a penalty for not filing Form 8453-R?
Failure to properly authenticate the electronic filing can result in the report being rejected or treated as unfiled, potentially triggering penalties under ACA rules (though the underlying fee is now repealed).

Where do I get the latest information?
Visit www.irs.gov/Form8453R for future developments.

Final Notes for Compliance Professionals

Although the ACA provider fee has ended, understanding legacy forms like 8453-R remains valuable for:

  • Amended returns or audits of prior fee years
  • Training new staff on IRS e-file authentication procedures
  • Comparing with current e-file declaration forms (8453 series)

For any questions about historical ACA reporting, consult a qualified tax advisor or refer directly to IRS.gov. This article is for informational purposes only and is based on official IRS publications as of 2026.

Keywords: IRS Form 8453-R, Form 8453-R instructions, electronic filing declaration Form 8963, ACA health insurance provider fee, Form 8963 e-file requirements.

Sources: IRS Form 8453-R (Rev. January 2020), Instructions for Form 8963 (Rev. January 2020), About Form 8963 page on IRS.gov.