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TF5095N 2022 Laser 1095B ACA IRS Copy Continuation Sheet 8 1/2 x 11"  QTY 25

TF5095N 2022 Laser 1095B ACA IRS Copy Continuation Sheet 8 1/2 x 11" QTY 25

$16.45

TF5095N 2022 Laser 1095B ACA IRS Copy Continuation Sheet
Size: 8 1/2 x 11"
This form is used in addition to the 1095B IRS Copy when an employee has more than 6 dependents for IRS reporting. 
This is a landscape format form mandated for reporting to IRS.
Meet your reporting requirements under the Affordable Care Act (ACA).
Use to report employees who are covered under your health plan.

    • 1-sided form
    • Black ink imprint
    • Compatible with laser or inkjet printers
    • For original 1095L IRS copy that works with this form, see product TF5095L
    • For employers with 50 or more full-time employees (FTEs) that worked at least one month during the year, that have more than 6 dependents.
    • For self-insured employers, with 50 or more full-time employees that worked at least one month during the year, that have more than 6 dependents.
    • This form is not available in multiple copies.  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).
    • 1 filing per sheet.
    • 25 per pack


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