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B95BPERFI05 - 2up Blank 1095-B Form (with Instructions)


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$ 25
Qty: Order a minimum of 25 and in multiples of 25
! Order in multiples of 25

Blank Form 1095-B. Use this blank laser form for printing form 1095-B. Instructions are preprinted on the back. A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage. Order by the number of sheets needed.

Note:  Please check your software for 1095 Envelope compatibility.

Construction: Laser Blank
Form: 1095-B
Pages: 1
Size: 8 1/2" x 11"
Forms /Sheet: 2up
Horizontal Perforation: 5 1/2"