4020: Small Business Health Insurance Deduction Information Form (Revision 2013-09)
Alabama · Alabama DOR · Used for tax years 2024, 2025, 2026
Alabama Form 4020 is the Small Business Health Insurance Deduction Information Form. It records an employer’s statement about employee count and compliance with the cited regulation, along with an employee’s statements about Alabama residency, wages, and adjusted gross income. Em
Who files this form
Form 4020 has sections for an employer and an employee to certify information for the Small Business Health Insurance Deduction.
- Employer: Check the box if the company employs fewer than 25 employees and complies with Alabama Department of Revenue Regulation 810-3-15.3-.01.
- Employee: Check all boxes that apply: you are an Alabama resident; you earn no more than $50,000 in wages from the qualifying employer; and your total adjusted gross income is no more than $75,000 if filing single or $150,000 if married filing jointly.
The form does not state who must submit it to the Department of Revenue.
Common mistakes
- Not keeping a copy: The form reminds employers and employees to each retain a copy for their records.
- Overlooking applicable employee boxes: Employees are instructed to check all boxes that apply.
- Certifying inaccurate information: Both signature sections declare, under penalties of perjury, that the information is true and correct to the best of the signer's knowledge.
Questions people ask
What does the employer certify?
The employer certifies that the company employs fewer than 25 employees and complies with Regulation 810-3-15.3-.01 administered by the Alabama Department of Revenue.
What income amounts appear in the employee section?
The employee section lists wages of no more than $50,000 from the qualifying employer and total adjusted gross income of no more than $75,000 if filing single or $150,000 if married filing jointly.
Who signs the form?
The employer section asks for a signature, title, and date. The employee section asks for a signature and date. Both include a declaration under penalties of perjury.
Should both parties keep a copy?
Yes. Employers and employees should each retain a copy for their records.
Where can I ask specific questions about Act 2011-155?
The form lists (334) 242-1099 for individual income tax, (334) 242-1200 for corporate income tax, and (334) 242-1033 for pass-through entities.