If you, your spouse, or one of your dependents were enrolled in Medicaid, ARKids, or the Arkansas Works Program at any time in 2020, DHS will mail you an IRS tax form 1095-B, upon request. Forms will be mailed throughout the year, upon request, beginning January 22, 2021. Some people could receive their form before others.
- You will want to keep it with your important tax documents.
- Check WWW.IRS.GOV or tax form 1040 instructions to see if you are required to file a federal income tax return.
- A person does not need the information on Form 1095-B to file an income tax return.
Requests for 1095-B forms can be made by:
- Calling the helpdesk at 844-461-3860
- Sending an email request to 1095BFormRequest@DHS.Arkansas.Gov
- Mailing a request to P.O. Box 8848, Pine Bluff, AR 71611-8848
Information You Need to Give DHS with Your Request
For requests made by email and U.S. mail, please include the recipient’s name, the tax year for which you are requesting a form, a phone number where you can be reached for questions, and a return email or mailing address to where the form will be sent.
Please contact your local DHS county office or the helpdesk for questions.
A person does not need the information on Form 1095-B to file an income tax return.