IRS Release Status:FINAL


Sample Excel Import File:  Coming Soon 1095-C 2017.xlsx

What's New for 2017

  • No Changes


Import Form Fields:

Field NameSizeType DescriptionNotesPart
See Form Filer Common Fields

Filer fields common to all form types.

See Recipient Common Fields

Recipient fields common to all form types.

Record Type1TextRecord Type is a required field and it indicates if a record is the Responsible Individual/Employee. Use E for Employee/Responsible Individual & C for Covered Individual 
Box 1 - 6 Employee
CharacterEmployeeFiler InfoPart I
Box 7-13 ALE MEMBER (Employer)
CharacterApplicable Large Employer MemberRecipient InfoPart I

Box 1 Name

40Text

Box 1: Name of employee


Part I
Box 2 TIN11TIN

Box 2: Social security number (ssn)


Part I
Box 3 Address Deliv/Street40CharacterBox 3: employee address Recipient address line 1Part I

Box 4 City

40Character

Box 4: employee city

 Recipient cityPart I
Box 5 State2CharacterBox 5: employee State or province Recipient US state or Canadian province (Use state abbreviation)Part I
Box 6 Zip10CharacterBox 6: employee zip Recipient US zip or Canadian postal codePart I
Box 7 Name40CharacterBox 7: Name of employerFiler Name or company namePart I
Box 8 TIN11CharacterBox 8: Employer identification number (EIN) Filer TIN (EIN or SSN)Part I
Box 9 Address Deliv/Street40CharacterBox 9: Employer street address (including room or suite)Filer address line 1Part I
Box 10 Contact20CharacterBox 10: Contact telephone number Filer contact phone numberPart I
Box 11 City40CharacterBox 13: Employer city Filer cityPart I
Box 12 State2CharacterBox 14: Employer State Filer US state or Canadian province (Use state abbreviation)Part I
Box 13 Zip10CharacterBox 13: Employer Zip Filer US zip or Canadian postal codePart I
Box 14 Offer coverage2CodeBox 14: Offer of Coverage (enter required code) 1A / 1B / 1C / 1D / 1E / 1F / 1G / 1H / 1J / 1K (All12Months or Jan - Dec)Part II
Box 15 Month Premium12AmountBox 15: Employee Share of lowest cost monthly premium....All12Months or Jan - DecPart II
Box 16 Safe harbor2CodeBox 16: Applicable Section 408H Safe Harbor....2A / 2B / 2C / 2D / 2E / 2F / 2G / 2H / (All12Months or Jan - Dec)Part II
Box 17- 34 Covered Individuals
CharacterCovered IndividualsEmployee DependentsPart III
Last Name/Company40CharacterCovered Individual last name
Part III
Middle Initial12CharacterCovered Individual Middle initial
Part III
First Name40CharacterCovered Individual first name
Part III
Suffix2CharacterCovered Individual suffixJr , SrPart III
Name Line 240CharacterCovered Individual name line 2Additional name linePart III
Social Security Number11TINCovered Individual SSN
Part III
Date of Birth10DateCovered Individual DOB (if SSN is not available)MM/DD/YYYY or M/D/YYYYPart III
Covered All 12 Months1CheckboxCovered Individual covered all 12 monthsX / Y / T / 1 = CheckedPart III

January Coverage

1Checkbox

January Coverage

X / Y / T / 1 = CheckedPart III
February Coverage1CheckboxFebruary CoverageX / Y / T / 1 = CheckedPart III
March Coverage1CheckboxMarch CoverageX / Y / T / 1 = CheckedPart III
April Coverage1CheckboxApril CoverageX / Y / T / 1 = CheckedPart III
May Coverage1CheckboxMay CoverageX / Y / T / 1 = CheckedPart III
June Coverage1CheckboxJune CoverageX / Y / T / 1 = CheckedPart III
July Coverage1CheckboxJuly CoverageX / Y / T / 1 = CheckedPart III
August Coverage1CheckboxAugust CoverageX / Y / T / 1 = CheckedPart III
September Coverage1CheckboxSeptember CoverageX / Y / T / 1 = CheckedPart III
October Coverage1CheckboxOctober CoverageX / Y / T / 1 = CheckedPart III
November Coverage1CheckboxNovember CoverageX / Y / T / 1 = CheckedPart III
December Coverage1CheckboxDecember CoverageX / Y / T / 1 = CheckedPart III
See Form Common Fields

Form fields common to all form types.


1095-C Form: 



IRS 1095-C Form:  1095-C Form

IRS 1095-C Instructions:  1095-C Instructions

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