Affordable Care Act Form 1095-B
Affordable Care Act Form 1095-B
Click Images to Enlarge

Number of
Lot Price
50 $19.20 
100 $36.60 
200 $64.03 
300 $77.76 
500 $105.77 
1000 $181.25 
>1000 Call us at
or Email Us For Price

Self-insured employers with less than 50 full-time employees, or insurers, must issue this form to employees/recipients and submit to the IRS as proof of healthcare coverage. Form 1094-B is the related transmittal.

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

There are no templates available for this product

Any tax forms ordered today will ship on Thursday July 25, 2024 if Ground shipping is chosen
They will ship on Wednesday July 24, 2024 if Express shipping is chosen