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TF5506 2019 Pressure Seal ACA 1095B Health Coverage 8 1/2 X 14"

Manufacturer: NEBS
Manufacturer Part No: TF5506
TF5506 2019 Pressure Seal ACA 1095B Health Coverage
Size: 8 1/2 X 14"
Make your own self-mailer.
Small glue capsules around the edge of forms burst when run through a sealing machine creating a bond, thus creating a self-mailer.

This form is used by insurance carriers for reporting which months the insured and his or her family were covered under the plan.

  • 2-sided form
  • 1 filing per sheet
  • Packaged 500 forms per carton.
  • Black ink imprint
  • Pressure Seal Forms - for Laser Form please 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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Starting at $160.20

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$160.20 TF5506 2019 Pressure Seal ACA 1095B Health Coverage 8 1/2 X 14"

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