2up Blank 1095-B Form w/instructions (B95BPERFI05)

Description 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"