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Is the $3,000 PSO exclusion for payment of health care premiums reported to the IRS on Form 1009-R or Form 1040?

exclusion form health care IRS payment premiums PSO reported
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Is the $3,000 PSO exclusion for payment of health care premiums reported to the IRS on Form 1009-R or Form 1040?

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To receive this tax benefit, the eligible retired PSO must report the excluded funds on IRS Form 1040

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