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2017 Bulk Laser 1095C Employer Provided Health Insurance

Item#: Size:
Quantity 1 2 3 4 5
TF5096B  1-Part/Original $65.99 $124.99 $177.99 $225.99 $266.99
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.