Indiana Form HRA-1 is a worksheet from the Indiana Department of Revenue that helps an employer prove they qualify for the Health Reimbursement Arrangement tax credit by listing employees and showing which employees were covered by an HRA during the tax year. It’s essentially a support document: you generally do not submit it with your return, but you should complete it and keep it with your records because Indiana may request it during a review or audit. The form is built around two key ideas: (1) identifying the employer and employee counts for the year, and (2) listing each employee and whether they were covered by your HRA, along with the correct “employer designation code” tied to where their W‑2 was issued and whether it was provided to the department. A major limitation is that if you are a pass-through entity (like a partnership or S corporation), this credit generally does not flow through to owners, and it can’t be used to reduce certain pass-through entity taxes or composite withholding taxes.
How To File It (And Where It Goes)
Form HRA-1 is not normally filed with your tax return. Instead, complete it as your internal backup documentation for the HRA credit you claim, and keep it available in case Indiana asks you to provide it later. If your employee list is longer than the space provided, you can attach extra pages by using additional copies of the worksheet.
How To Complete Indiana HRA-1
Header Section (Top Of Form)
Fill out every item at the top before you start Part A or Part B.
- Taxpayer Name: Enter the legal name of the employer claiming the credit.
- Federal Employer Identification Number: Enter your business’s FEIN.
- Tax Year: Enter the year your tax year begins. For a fiscal year, you still enter the beginning year (example: a year that starts in 2025 gets “2025”).
- Enter Total Number Of Employees During The Year: This is the total number of employees you had during the year (count all employees who worked during the year, not just those employed at the end).
- Enter The Maximum Number Of Employees During The Year: This is the highest employee count you had at any single point during the year (your peak headcount).
Part A: Other FEINs Used For Your Employees’ W‑2s
Only complete Part A if you have employees who were paid by you but had W‑2s issued under a different FEIN than the one in the header (for example, a related company, payroll agent, or different reporting entity).
In the Part A table, you’ll see rows labeled (1, 2, 3, 4, 5… depending on the form layout). For each row you use:
- Federal Employer Identification Number: Enter the “other” FEIN that issued W‑2s for wages paid by you.
- Number Of Employees: Enter the number of employees whose W‑2s for your wages were issued under that FEIN.
Important counting rules so you don’t double-count:
- If you issued a W‑2 to an employee and that W‑2 was (or will be) provided to the department, do not count that employee under any Part A employer row.
- If an employee has W‑2s under multiple “other FEINs” and you did not issue a W‑2 yourself, include that employee only once, under the first listed Part A employer that provides (or will provide) the W‑2 to Indiana.
Part B: Employee-By-Employee Listing (The Most Important Part)
Part B is where you list each employee you want considered for the credit. The form is strict: if you forget to list someone, they generally won’t be treated as covered for credit purposes.
For each employee row, complete every column:
- Employee Name: Enter the employee’s full name.
- Social Security Number: Enter the employee’s SSN.
- Hire Date: Enter the hire date in MM/DD/YYYY format; if the employee was hired more than once during the year, use the most recent hire date.
- Termination Date:
- If the employee left before year-end, enter the final separation date in MM/DD/YYYY format.
- If the employee left multiple times, use the most recent termination date.
- If the employee was still employed at the end of the year, enter 12/31/9999.
- Covered / Non-Covered Employee:
- Enter C if the employee was covered by your HRA at any time during the tax year.
- Enter N if the employee had no HRA coverage at any time during the year.
- Employer Designation Code (See Instructions): This code tells Indiana which employer/W‑2 source applies for that employee.
- Use 00 if you issued the employee’s W‑2 and it was supplied to the department.
- If the employee’s W‑2 was issued under a different FEIN and that W‑2 was supplied to the department, use the Part A row number as a two-digit code (example: Part A row 1 becomes 01).
- Use 99 if a W‑2 exists but it was not supplied to the department.
- Special note for fiscal-year filers: use the employer designation code for the employer you expect will ultimately issue the W‑2s.
Practical Tips To Avoid Rework
- Keep a simple checklist: every employee you want counted must have a complete row with name, SSN, hire date, termination date, coverage letter, and employer code.
- If you need more space, print extra copies of the worksheet and attach them—don’t squeeze names or skip columns.
- Make sure your “total employees” and “maximum employees” numbers make sense together (total for the year can be larger than peak headcount).