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Form 8453-F for Tacoma Washington: What You Should Know

J-2, or M-1 nonimmigrant visa status; or in the U.S. as a foreign student (B-1, B-2, B-3, and J-1) under a U.S. sponsored nonimmigrant visa.  If you are a nonresident alien, you must complete, sign, and return Form 8843 by the due date. Form 8473 — Medical Payment Authorization Form If you need this form to make any health care payment, you should use Form 772 to pay your federal income, FICA, Medicaid, Medicare, Medicaid expansion, and CHIP, or SHIP premiums for the year: Use Form 8873 for payments to State Unemployment Insurance Program (SUSIE). Make sure you have the information on your State SUSIE payment slip (also called a Form 1128) in the correct format. Form 8673 — Request for Health Care Benefits If you are using or applying for any health care benefit, such as Medicare, Medicaid, or prescription drug coverage, such as the health and dental plans (or Medicare Supplement or Median), you must include this form. You can download this form from SSA.gov or from your social security office. To learn more about these forms and how to use and apply for them — download this SSA fact sheet. Do not use Form 8683 or 8688. The form is for applicants who have a Social Security number (SSN) that is different from their name, and you must complete both pieces of information individually.  For additional information about this specific form — download or use the following forms. If you are a non-resident alien, you must complete, sign, and return Form 8867. You will be instructed on what to do when you submit a Medicare Supplement or Median claim form or application. The form is used to request health care benefits for yourself and to request benefits for certain dependents of non-citizen family members of U.S. citizens, lawful permanent residents, or refugees.  If you are a Social Security Number (SSN) holder or if you have a non-citizen family member with a valid U.S. social security number, and you need a copy of a Social Security payment slip (Form 1099-S), you have the following three options. SSA may send you an order from the Social Security Administration's Wage and Tax Center for a paper copy of the document.

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