Form 1095-B must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage.

Be sure to order enough to give to your employees and submit to the IRS.

Three 1094 Transmittal Forms are included with your order.



Recently Viewed   See More

Affordable Care Act Form Blank 1095-C w/Instructions

Starting at: $19.20

Burris Blank 6UP Tag Template for Microsoft Word

Starting at: $0.00

Affordable Care Act Form 1095-B

Starting at: $19.20

Burris Blank 12UP Square Tag Template for Microsoft Word

Starting at: $0.00

Affordable Care Act 1095 Double Window Envelope (Self Seal)

Starting at: $15.00

Burris Blank 18UP Tag Template for Microsoft Word

Starting at: $0.00