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TF5400 2019 Laser ACA 1094B Transmittal Health Coverage 8 1/2 X 11"

Manufacturer: NEBS
Manufacturer Part No: TF5400
TF5400 2019 Laser ACA 1094B Transmittal Health Coverage
Size: 8 1/2 X 11"
Meet your reporting requirements under the Affordable Care Act (ACA).
A Summary Transmittal is required for submitting 1095B forms to the IRS.
This form accompanies form 1095B when mailed to IRS.

  • 1 filing per sheet
  • 1-sided form
  • Shrinkwrapped in packs of 25.
  • Black ink imprint
  • Compatible with laser or inkjet printers.
  • Laser form - for use with 1095B see product TF5095 here
  • For employers with fewer than 50 full-time employees (FTEs) that worked at least one month during the year, that provide health plans.
  • For self-insured employers, with fewer than 50 full-time employees that worked at least one month during the year, that provide health plans.
  • 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).
  • 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 TF5400 2019 Laser ACA 1094B Transmittal Health Coverage 8 1/2 X 11"

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