TF5095C Laser 1095B ACA Continuation Sheet 8 1/2 x 11" QTY 25

TF5095C Laser 1095B ACA Continuation Sheet
Size: 8 1/2 x 11"
This form is used in addition to the 1095B when an employee has more than 6 dependents.
Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report employees covered by your health plan.

• 1-sided form
• For employers with fewer than 50 full-time employees (FTEs) that worked at least one month during the year, that have more than 6 dependents.
• For self-insured employers, with fewer than 50 full-time employees that worked at least one month during the year, that have more than 6 dependents.
• You must order for the total number of copies you need (ex. 50 employees - in most cases you will need one copy for the employee, one for the employer, and one for the IRS so you must order quantity 150).
• 25 per pack

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