The Pennie income attestation form is a one-page document you submit when Pennie’s automated checks can’t confirm the household income on your health insurance application. You fill in your projected annual income, check a reason for the mismatch, sign and date it, and send it back to Pennie — either uploaded through your account or mailed to Pennie Customer Service, PO Box 2008, Birmingham, AL 35203.1Pennie. What Documents Should You Submit to Resolve a Data Matching Issue You have 90 calendar days from the date of your eligibility notice to get it in.
Why Pennie Asked You for This Form
Every Pennie application is checked against IRS records and state wage databases. When your reported income doesn’t line up with those sources, Pennie opens what it calls a Data Matching Issue and sends an eligibility notice by mail or email, depending on the preference you chose when you applied.2Pennie. Your Eligibility Notice
That notice starts a 90-day window called the Reasonable Opportunity Period. If Pennie doesn’t receive acceptable documentation within those 90 days, it can remove your Advance Premium Tax Credits or terminate your policy.3Pennie. What Is the Reasonable Opportunity Period
Most people clear a Data Matching Issue with pay stubs, a self-employment ledger, or a Social Security award letter.4Pennie. What Are the Required Documents to Verify Information Included on My Application The attestation form is for situations where none of those exist: you just started freelancing, your hours are unpredictable, or you recently lost a job and have no current pay stubs to show.
Filling Out the Form
The form is a single-page PDF available on the Pennie agency website. It has four steps.
Step 1. Attest to your current income. Enter your name, full address including county, and your household’s projected annual income for the coverage year. This dollar amount must match the income figure on your Pennie application. If the two numbers don’t match, the form won’t resolve the discrepancy.
Step 2. Select a reason for the mismatch. Check the box that best describes why your reported income differs from what the databases show. The options include reduced hours, a pay cut, job loss, loss of other income, fluctuating hours, and changes tied to disability, retirement, FMLA, or a sabbatical. If none of those fit, check “A reason not listed above” and explain in Step 3.
Step 3. Add details. Use the open text field to describe your situation in a sentence or two. Even if you checked a specific box above, a short explanation helps the reviewer move faster.
Step 4. Sign and date. Print your name, then sign and date. You are attesting under penalty of perjury that the information is accurate. Intentionally misreporting income can bring legal consequences and an obligation to repay any tax credits you received.5CMS. Frequently Asked Questions on Health Insurance Marketplaces and Income Verification
Getting the Projected Income Number Right
The income figure on this form is your household’s projected Modified Adjusted Gross Income (MAGI) for the entire calendar year, not your current monthly pay times twelve. MAGI is your adjusted gross income plus any untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.6HealthCare.gov. Modified Adjusted Gross Income (MAGI)
Start with what you’ve already earned this year and project forward realistically. If you worked a higher-paying job for three months before a layoff, that income still counts toward the annual total. Add Social Security benefits, unemployment compensation, taxable interest, dividends, and net self-employment income. Supplemental Security Income (SSI) is excluded from MAGI, and child support you receive is not counted either.6HealthCare.gov. Modified Adjusted Gross Income (MAGI)
If your household includes a spouse or dependents who earn income, add their projected earnings too. Every member of the tax household counts. Line 11 of your most recent Form 1040 is a useful starting point, which you then adjust for anything that has changed since.
Reporting Zero or Very Low Income
If your household expects little or no income, write that dollar figure on the form. There’s no separate checkbox for zero income. Very low reported income may qualify you for Medicaid rather than marketplace subsidies, so an attestation of very low income could route your coverage differently.
If Your Income Changes Later
The attestation resolves the data matching issue at one point in time. It doesn’t lock in that income estimate for the rest of the year. If your income shifts after you submit — a new job, a raise, a lost client — update your Pennie application right away to keep your monthly subsidy accurate and reduce the chance of owing money back at tax time.7Pennie. What to Include as Income
Submitting the Completed Form
Uploading through your Pennie account is the fastest option. Log in at pennie.com, click “My Applications” on the left side, find your current application, and click “Verifications & Documents” under the actions section. Follow the prompts to upload a scan or photo of your signed form. The file must be under 5 MB and in PDF, JPG, JPEG, PNG, BMP, or GIF format. Avoid special characters like colons, semicolons, or asterisks in the file name.8Pennie. How Do I Submit Documents
To mail the form, send it to:
Pennie Customer Service
PO Box 2008
Birmingham, AL 352031Pennie. What Documents Should You Submit to Resolve a Data Matching Issue
Mailed documents take longer to process. If your 90-day window is running short, the online portal is the safer choice. Whichever method you use, keep a copy of the signed form. Pennie will send a notification once the document has been processed and the verification is complete.
For questions about your eligibility notice or submission problems, call Pennie Customer Service at 1-844-844-8040, Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern (February through mid-October). Hours typically extend during open enrollment.9Pennie. Contact Us
What Happens After You Submit
The income you attest to affects your tax return. When you file, you complete IRS Form 8962 to reconcile the Advance Premium Tax Credits you received during the year with the credit your actual income earned you.10Internal Revenue Service. Instructions for Form 8962 You’ll need Form 1095-A, which Pennie sends each January, to do that.
If your actual income comes in lower than your estimate, you’ll likely get a larger credit at tax time. If it comes in higher, you’ll owe the excess back. For tax year 2026 and beyond, there is no cap on how much excess advance credit you must repay — the full overpayment is added to your tax bill.11Internal Revenue Service. Questions and Answers on the Premium Tax Credit That’s a real change from prior years, and it’s the strongest reason to make your attested figure as accurate as you can.
If Pennie reduces or drops your financial assistance even after you submit the form, you have 90 days from the final eligibility determination to appeal. Start at agency.pennie.com/appeals or call 1-844-844-8040.12Pennie. Appeals Before appealing, confirm Pennie received everything it requested — sending in a missing document sometimes triggers a corrected decision on its own.13HealthCare.gov. How to Appeal a Marketplace Decision