1095-B Forms - Blank With Fold Perforation - Instructions On Back

Form 1095-B  Blank Full page form, with a fold perforation at 5 1/2", includes 1095-B instructions on back.

Use this blank form for 1095-B information.  Order by number of employees.  Instructions are printed on the back of the form.  The related transmittal is form 1094-B.

A 1095-B form must be issued to employees by SELF-INSURED employers with LESS than 50 full time employees (including full-time equivalent employees).