TF5096C 2023 Laser 1095C ACA Continuation Sheet 8 1/2 x 11" QTY 25
$17.71
TF5096C 2023 Laser 1095C ACA Continuation Sheet
Size: 8 1/2 x 11"
This form is used in addition to the 1095C when an employee has more than 6 dependents.
Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report whether employees were offered health insurance.
ages paid.
- 1-sided form
- Black ink imprint
- Laser form - for original 1095C forms see product TF5096
- 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).
- Compatible with laser or inkjet printers.
- 1 filing per sheet
- 25 per pack
