1095 (ACA) Pressure Seal Tax Forms
1095B-Blank
1095B-Blank-2
2021 IRS APPROVED FORMAT
Part Number: 1095B-BLANK

14″ 1095-B Pressure Seal Form – Health Coverage (1095B-Blank)

Pressure Seal EZ Fold blank face with instructions on back. Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage.

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Fold

EZ-Fold
Size

8.5" x 14"

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