1095-B Blank Full Page Form w/ Instructions on Back
B95BPERFI05
$0.29
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.
Specifications: Construction: Laser Blank Form: 1095-B Pages: 1 Size: 8 1/2" x 11" Forms /Sheet: 2up Horizontal Perforation: 5 1/2"
