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Laser 1095-C ACA Continuation Sheet, IRS Copy Item No. TF5096N     Size: 11" x 8 1/2"

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Laser 1095-C ACA  Continuation Sheet, IRS Copy

Laser 1095-C ACA Continuation Sheet, IRS Copy Item No. TF5096N

Don't forget the continuation form if you have six dependents or more! Use this form in conjunction with TF5096.

 

Meet your reporting requirements under the Affordable Care Act (ACA). Use to report employees who are covered under your health plan.

 

Report to IRS in mandated landscape format.

 

Paper Filing Due Date: To IRS, February 28 // To Recipient January 31




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