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IRS Release Status: FINAL
Sample Excel Import File: 1095-C 2019.xlsx
Import Form Fields:
Field Name | Size | Type | Description | Notes | Part |
---|---|---|---|---|---|
See Form Filer Common Fields | Filer fields common to all form types. | ||||
See Recipient Common Fields | Recipient fields common to all form types. | ||||
Record Type | 1 | Text | Record 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 | Character | Employee | Filer Info | Part I | |
Rcp Account | 25 | Character | Recipient Account Number | ||
Last Name/Company | 40 | Character | Employee last name/Company Name | ||
First Name | 40 | Character | Employee First name | ||
Rcp TIN | 11 | TIN | Recipient Tax ID Number | ||
Address Deliv/Street | 40 | Character | Employee Delivery address | ||
Address Apt/Suite | 40 | Character | Employee Apartment Suite | ||
City | 40 | Character | Employee City | ||
State | 23 | Character | Employee State | ||
Zip | 15 | Character | Employee Zip | ||
Box 14-16 Employer Offer and Coverage | Character | Employer Offer and Coverage | Recipient Info | Part II | |
Box 14 Offer coverage | 2 | Code | Box 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 Premium | 12 | Amount | Box 15: Employee Share of lowest cost monthly premium.... | All12Months or Jan - Dec | Part II |
Box 16 Safe harbor | 2 | Code | Box 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 | Character | Covered Individuals | Employee Dependents | Part III | |
Last Name/Company | 40 | Character | Covered Individual last name | Part III | |
Middle Initial | 12 | Character | Covered Individual Middle initial | Part III | |
First Name | 40 | Character | Covered Individual first name | Part III | |
Suffix | 2 | Character | Covered Individual suffix | Jr , Sr | Part III |
Name Line 2 | 40 | Character | Covered Individual name line 2 | Additional name line | Part III |
Social Security Number | 11 | TIN | Covered Individual SSN | Part III | |
Date of Birth | 10 | Date | Covered Individual DOB (if SSN is not available) | MM/DD/YYYY or M/D/YYYY | Part III |
Covered All 12 Months | 1 | Checkbox | Covered Individual covered all 12 months | X / Y / T / 1 = Checked | Part III |
January Coverage | 1 | Checkbox | January Coverage | X / Y / T / 1 = Checked | Part III |
February Coverage | 1 | Checkbox | February Coverage | X / Y / T / 1 = Checked | Part III |
March Coverage | 1 | Checkbox | March Coverage | X / Y / T / 1 = Checked | Part III |
April Coverage | 1 | Checkbox | April Coverage | X / Y / T / 1 = Checked | Part III |
May Coverage | 1 | Checkbox | May Coverage | X / Y / T / 1 = Checked | Part III |
June Coverage | 1 | Checkbox | June Coverage | X / Y / T / 1 = Checked | Part III |
July Coverage | 1 | Checkbox | July Coverage | X / Y / T / 1 = Checked | Part III |
August Coverage | 1 | Checkbox | August Coverage | X / Y / T / 1 = Checked | Part III |
September Coverage | 1 | Checkbox | September Coverage | X / Y / T / 1 = Checked | Part III |
October Coverage | 1 | Checkbox | October Coverage | X / Y / T / 1 = Checked | Part III |
November Coverage | 1 | Checkbox | November Coverage | X / Y / T / 1 = Checked | Part III |
December Coverage | 1 | Checkbox | December Coverage | X / Y / T / 1 = Checked | Part III |
See Form Common Fields | Form fields common to all form types. |
1095-C Form:
IRS 1095-C Form: 2019 1095-C Form
IRS 1095-C Instructions: 2019 1095-C Instructions
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