Pay in 4 interest-free payments of $8.33 Learn more
Ships within 48 hours · Estimated delivery Oct 21 - Oct 26
Overall Size: 3 7/8" x 8 7/8"
4 Part Set Includes: Copy A
Moisture Seal and Self-Seal Versions Available
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Current Year Employee instructions are on the back side
1095-C - Employer-Provided Health Insurance Offer and Coverage Page 1 Tax Software Overall Size: 3 7/8" xForm 1095 C Employers with 50+ full time equivalent employees must issue form 1095 C to employees and file with the IRS as prof of healthcare coverage. Form 1094 C is the related transmittal sent to the IRS. ALL Covered Individuals need to be listed on Page 2 of the 1095 C. Either order item B1095C205 with this form or order both pages together as a kit with item number B1095C1205. (Approved 2025 version coming soon) Please contact us for other
US$ 529.50
US$ 19.95
US$ 30.00
