IRS Forms 1095-B

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FORM 1095-B

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IRS.gov: Affordable Care Act 1095-B, cLine 1, Name of Responsible Individual IRS.gov: Affordable Care Act 1095-B, Part I  Line 2, Social Security Number of Responsible Individual IRS.gov: Affordable Care Act 1095-B, Part I  Line 3, Birthdate (MM/DD/YYYY) of Responsible Individual if SSN is blank. IRS.gov: Affordable Care Act 1095-B, Part I  Lines 4-7, Complete Mailing Address of the Responsible Individual IRS.gov: Affordable Care Act 1095-B, Part I  Line 8, Letter Code of Origin of Policy IRS.gov: Affordable Care Act 1095-B, Part I  Line 9, SHOP Identifier (Leave blank for 2015 filing) IRS.gov: Affordable Care Act 1095-B, Part II  Lines 10-15, Name, EIN, and Complete Mailing Address for the Employer Sponsoring the Coverage IRS.gov: Affordable Care Act 1095-B, Part III  Lines 16-22, Name, EIN, and Complete Mailing Address of Issuer/ Other Coverage IRS.gov: Affordable Care Act 1095-B, Part IV  Column (a), Name of each Covered Individual IRS.gov: Affordable Care Act 1095-B, Part IV  Column (b), Social Security Number (SSN) of each Covered Individual IRS.gov: Affordable Care Act 1095-B, Part IV  Column (c), Birthdate (MM/DD/YYY) of each Covered Individual if SSN is not available IRS.gov: Affordable Care Act 1095-B, Part IV  Column (d), Individual Covered for 12 months IRS.gov: Affordable Care Act 1095-B, Part IV  Column (e), Coverage each month if individual wasn't covered for all 12 months




IRS.gov: Affordable Care Act 1095-B, Part IV  Column (a), Name of each Covered Individual (Continuation) IRS.gov: Affordable Care Act 1095-B, Part IV  Column (b), Social Security Number (SSN) of each Covered Individual (Continuation) IRS.gov: Affordable Care Act 1095-B, Part IV  Column (c), Birthdate (MM/DD/YYY) of each Covered Individual if SSN is not available (Continuation) IRS.gov: Affordable Care Act 1095-B, Part IV  Column (d), Individual Covered for 12 months (Continuation) IRS.gov: Affordable Care Act 1095-B, Part IV  Column (e), Coverage each month if individual wasn't covered for all 12 months (Continuation)



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