Page 14 - 2024 Tax Catalog

ACA RECIPIENT FORMATS 14

ACA Recipient Formats

Order in increments of 25

ACA RECIPIENT FORMATS
The following forms have been developed to simplify the
process of issuing and mailing recipient copies . These forms
cannot be filed with the IRS. Check with your software for
compatibility . Order 1 form per employee/insured .

1095-B
Item # Description Form Type
B95BFPREC05 1095-B Full Page Recipient Form
w/Instructions on Back Preprinted Laser
B95BPERFI05 1095-B Form w/Instructions on Back Blank Laser
B95BLANK 1095 w/Fold Perforation Blank Laser
81650* Pressure Seal 14" EZ 1095-B or Blank
1095-C Pressure Seal
1095-B Full Page Recipient Form 1095-C Full Page Recipient Form
1095-C w/Instructions on Back w/Instructions on Back
Item # Description Form Type B95BFPREC05 B95CFPREC05
B95CFPREC05 1095-C Full Page Recipient Form
w/Instructions on Back Preprinted Laser
B95CHPREC05 1095-C Half Page Recipient Form
w/Instructions on Front Preprinted Laser
95CRCBT 1095-C Blank Top Half Page Recipient Instructions Here
Form w/Instructions on Back Preprinted Laser
B95CPERFI05 1095-C Form w/Instructions
on Back Blank Laser
B95BLANK 1095 w/Fold Perforation Blank Laser
PS95CISB* Pressure Seal 14" EZ Fold 1095-C Blank
w/Instructions on Back Pressure Seal
81652* Pressure Seal 14" EZ Fold 1095-C Preprinted
Pressure Seal Instructions Here
81650* Pressure Seal 14" EZ 1095-B or Blank
1095-C Pressure Seal
*Order in increments of 500 .

1095-C Half Page Recipient Form Blank 1095-C Form w/Instructions
w/Instructions on Front on Back
B95CHPREC05 B95CPERFI05

COMPATIBLE
ENVELOPES
SEE PAGE 15.

Eccentric Z-Fold

1095-C Preprinted Pressure Seal
14" EZ Fold
81652