Tax HIA Engagement Letter

TAX HIA ENGAGEMENT LETTER

Parties and Engagement Date

Date of Engagement:   Tax years covered:

Scope of Engagement

The Firm will provide tax services specifically related to HIA matters, including preparation and filing of federal and state tax forms associated with Health Insurance Affordability determinations, calculation of applicable premium tax credit adjustments, preparation of related schedules, and communications with taxing authorities as necessary to resolve issues directly related to HIA items. Services do not include audit representation beyond matters explicitly agreed in writing, tax planning outside HIA scope, or services for unrelated tax periods.

Client Responsibilities

The Client will timely provide complete and accurate information required for the preparation of tax filings and related HIA submissions, including but not limited to wage statements, Form 1095 forms, prior tax returns, documentation supporting household composition and income, and responses to reasonable inquiries by the Firm. The Client certifies the accuracy of all information provided and will notify the Firm promptly of any material changes.

Fees and Payment

Fees for the engagement will be based on the time required by personnel to complete the services at standard hourly rates or at a mutually agreed fixed fee. Additional services outside the scope will be billed separately. Payment is due upon presentation of the invoice unless alternative arrangements are recorded below.

Taxpayer Identification Information

Provide taxpayer identification information below. The Firm will rely on these numbers when preparing returns and related submissions.

Social Security Number:   OR   Employer Identification Number:

Confidentiality, Records, and Limitations

The Firm will maintain the confidentiality of Client information consistent with professional standards. The Firm may disclose information when required by law or to professional advisors retained to assist in the engagement, with prior notice to Client where practicable. The Firm will retain workpapers for a minimum of seven years unless otherwise instructed; original documents provided by the Client will be returned upon request.

Termination and Dispute Resolution

Either party may terminate this engagement with written notice. Client remains responsible for fees and expenses incurred through the date of termination. Disputes arising from this engagement will be governed by the laws of the state indicated below and, unless otherwise agreed, resolved through binding arbitration conducted in the county of the Firm's principal office.

Client Representations and Certifications

By signing below, the Client makes the following certifications under penalty of perjury:

1. All information provided to the Firm for the preparation of tax filings is true, correct, and complete to the best of the Client's knowledge.
2. The Taxpayer Identification Number provided above is correct and the Client is not subject to backup withholding unless notified otherwise by the relevant authority.
3. The Client authorizes the Firm to discuss and disclose tax return information with third parties only as necessary to complete the engagement or as required by law, and to obtain and provide copies of tax records when reasonably necessary.
4. The Client understands that the Firm will rely on the Client's representations and documents and that the Firm has no obligation to independently verify factual information provided by the Client.
5. The Client accepts responsibility for the timely filing of returns and payment of any taxes, penalties, or interest, unless the Firm has expressly agreed to assist with such payments or filings as a separate service.

Acceptance

To accept this engagement, sign and date below. Signing authorizes the Firm to begin work on the terms set forth in this letter. If signing on behalf of an entity, signer warrants they have authority to bind the entity.

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