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TF5096N 2019 Laser 1095C ACA IRS Copy Continuation Sheet 8 1/2 X 11"

Manufacturer: NEBS
Manufacturer Part No: TF5096N
TF5096N 2019 Laser 1095C ACA IRS Copy Continuation Sheet
Size: 8 1/2 X 11"

This form is used in addition to the 1095C IRS Copy when an employee has more than 6 dependents for IRS reporting.
This is a landscape format form mandated for reporting to IRS.
Meet your reporting requirements under the Affordable Care Act (ACA). Use to report employees who are covered under your health plan.

  • 1-sided form
  • 1 Filing per sheet.
  • Black ink imprint
  • For original 1095C IRS copy that works with this form, see product TF5096L here
  • For employers with 50 or more full-time employees (FTEs) that worked at least one month during the year, that have more than 6 dependents.
  • For self-insured employers, with 50 or more full-time employees that worked at least one month during the year, that have more than 6 dependents.
  • This form is not available in multiple copies.  You must order for the total number of copies you need (ex. 50 employees - in most cases you will need one copy for the employee, one for the employer, and one for the IRS so you must order quantity 150).
  • Compatible with laser or inkjet printers.
  • Shrinkwrapped in packs of 25.
  • 100% Satisfaction Guarantee
  • Higher quantities are available at discounted prices.
  • Speak to a customer service specialist at 855-5FORMS5 or 855-536-7675. 8AM - 7PM EST Monday - Thursday and 8AM - 5PM EST on Friday.


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$13.20 TF5096N 2019 Laser 1095C ACA IRS Copy Continuation Sheet 8 1/2 X 11"

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