Wiki source code of IRS FORM 1095-B

Last modified by Derek K on 2024/02/07 22:29
Hide last authors
steveny 1.2 1 == FORM 1095-B ==
2
jackb 4.1 3 ===== //Click on the individual boxes below for specific IRS Instructions
steveny 1.2 4 [[image:attach:1.png]]// =====
5
6
7 |**Part I: Responsible Individual**
8 |(((
9 |[[Line 1, Name of Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e619]]
10 |[[Line 2, Social Security Number of Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e630]]
11 |[[Line 3, Birthdate (MM/DD/YYYY) of Responsible Individual if SSN is blank.>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e638]]
12
13 |[[Lines 4-7, Complete Mailing Address of the Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e643]]
14 |[[Line 8, Letter Code of Origin of Policy (Policy Origin Code)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e648]]
15 |[[Line 9, SHOP Identifier (Leave blank for 2015 filing)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e677]]
16 )))
17
18 |**Part II: Employer-Sponsored Coverage**
19 |[[Lines 10-15, Name, EIN, and Complete Mailing Address for the Employer Sponsoring the Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e693]]
20
21 |**Part III: Issuer or Other Coverage Provider**
22 |[[Lines 16-22, Name, EIN, and Complete Mailing Address of Issuer/ Other Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e704]]
23
24 |**Part IV: Covered Individuals**
25 |[[Column (a), Covered Individual's Name>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e712]]
26 |[[Column (b), Covered Individual's Social Security Number (SSN)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e717]]
27 |[[Column (c), Covered Individual's Birthdate (MM/DD/YYY) if Social Security Number (SSN) is not available>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e725]]
28 |[[Column (d), Covered all 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e730]]
29 |[[Column (e), Months of Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e738]]
30
31 ===== =====
32
jackb 4.1 33 //[[image:attach:2.png]]//
steveny 1.2 34
35
36 |**Part IV: Covered Individuals (Continuation)**
37 |[[Column (a), Name of each Covered Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e712]]
38 |[[Column (b), Social Security Number (SSN) of each Covered Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e717]]
39 |[[Column (c), Birthdate (MM/DD/YYY) of each Covered Individual if SSN is not available>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e725]]
40 |[[Column (d), Individual Covered for 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e730]]
41 |[[Column (e), Coverage each month if individual wasn't covered for all 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e738]]
42
jackb 4.1 43 ----
steveny 1.2 44
jackb 4.1 45 == Related Pages: ==
46
47
48 === [[IRS Forms 1095-C>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1095-C.WebHome]] ===
49
jackb 5.1 50 ====== Learn more about the IRS Form 1095-C. ======
jackb 4.1 51
52
53 === [[IRS Forms 1094-C>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1094-C.WebHome]] ===
54
jackb 5.1 55 ====== Learn more about the IRS Form 1094-C. ======
jackb 4.1 56
57
58 === [[IRS Forms 1094-B>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1094-B.WebHome]] ===
59
jackb 5.1 60 ====== Learn more about the IRS Form 1094-B. ======