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1095-B Full Page Recipient Form w/ Instructions on Back


Preprinted Form 1095-B. Full page with preprinted instructions on back. 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.

Compatible Envelopes: 95DWENV05 (Moisture Seal) | 95DWENVS05 (Self Seal) 

Construction: Laser Preprin
Form: 1095-B
Pages: 1
Size: 8 1/2" x 11"
Forms /Sheet: 1up
Horizontal Perforation: 5 1/2"

Minimum qty of 25. Order in increments of 25.