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2014. Instructions for Form 8965. Health Coverage Exemptions. (and instructions for figuring your shared responsibility payment). Department of the Treasury.In June 2014, he could have purchased self-only coverage for the period from July 2014 through June 2015 at a total cost to him of $5,000. Braden can claim the Form 8965. 2015. Health Coverage Exemptions. Department of the Treasury Information about Form 8965 and its separate instructions is at