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2017 Bulk Laser 1095C Employer Provided Health Insurance

Item#: Size:
Quantity 1 2 3 4 5
TF5096B  1-Part/Original $69.99 $131.99 $186.99 $237.99 $280.99
We recommend this quantity.
1.  Quantity

Benefits and Features

Meet your reporting requirements under the Affordable Care Act (ACA) by using this form to report whether employees were offered health insurance.

  • Typically used by payroll companies

    and Applicable Large Employers (ALEs) with 50+ employees.
  • One page with backer information per form;

    packaged 500 forms per carton.
  • Paper filing due date:

    to IRS by February 28 / to recipient by January 31.
  • Compatible with laser

    or inkjet printers.