Self-insured employers with less than 50 full-time employees, or insurers, must issue this form to employees/recipients and submit to the IRS as proof of healthcare coverage. Form 1094-B is the related transmittal.
Pre-printed 1-up laser cut sheet
1 form per sheet (Order by number of forms)
Actual Size: 8.5"W x 11"H
Compatible with envelope 7777
Minimum Order Quantity: 100