2.3.86 Command Code IRPOL

Manual Transmittal

December 14, 2016

Purpose

(1) This transmits revised IRM 2.3.86, IDRS Terminal Responses, Command Code IRPOL. Information Returns Processing Online (IRPOL) Command Code allows IDRS users to search, access, and display ACA forms - from insurance companies, employers, and ACA marketplaces - filed to the IRS in accord to the Patient Protection and Affordable Care Act (ACA) of 2010.

Material Changes

(1) Exhibit 2.3.86-1 - Document Code Availability Tax Year increased.

(2) Exhibit 2.3.86-2 - IRPOL Overview Screen added new fields, “INFORMATION-RETURN-STATUS-IND” and “DATA RECONCILIATION CODE (TBD)”.

(3) Exhibit 2.3.86-8 -Document Display Screen: 1095-A (Doc Code 07) section 12.1 Literal has changed from “Spouse Data” to “EMPLOYER DATA”.

Effect on Other Documents

IRM 2.3.86 dated October 20, 2015, is superseded.

Audience

IDRS USERS, SB/SE.

Effective Date

(01-31-2017)

S. Gina Garza
Chief Information Officer

Command Code IRPOL General Information

  1. Command Code (CC) Information Returns Processing Online (IRPOL) allows IDRS users to request on-line information from the Information Returns Database (IRDB).

  2. CC IRPOL can be used to request data for a particular Taxpayer Identification Number (TIN) for tax years (TY2016, TY2015, or TY2014).

Important Dates For Command Code IRPOL

  1. TY 2016 data should be accessible online on Tuesday, January 31, 2017.

Command Code IRPOL Valid Tax Years

  1. Three tax years (TY2014, TY2015, or TY2016) can be referenced in IRPOL currently.

IRPOL Help Screen

  1. The figure and table below show the validated fields for the IRPOL Help screen

    Figure 2.3.86-1

    This is an Image: 67908001.gif

    Please click here for the text description of the image.

    TIN Entry must be 9 numeric and unedited (no hyphens) for either an SSN or an EIN. TIN cannot be 000000000 or 999999999.
    TIN TYPE and VALIDITY Entry must be 0, 1, or 3 to respectively specify Valid SSN, Invalid SSN, or EIN extraction of Information Return Documents for the TIN.
    TAX YEAR Entry must be a valid Tax Year that is available on the Command Code IRPOL Valid Tax Years, IRM 2.3.86.3 for valid Tax Years.
    DOC CODE Entry must be any DOC CODE specified by Exhibit 2.3.86-1.

Document Code Availability by Tax Year

Valid Document Codes and available tax years are listed in the table below.

DOCUMENT TYPE DOC CODE TY2014 TY2015 TY2016
1094-B 11 X X X
1094-C 12 X X X
1095-A 07 X X X
1095-B 56 X X X
1095-C 60 X X X

IRPOL Overview Screen

This is an Image: 67908002.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN - This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE- This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year, See IRM 2.3.86-1 for valid Tax Years.
1.6 21 DOCUMENT CODE (00) “00” retrieves all documents
1.7 27 Literal- UNIQUE-ID=<
1.8 38 nnnnnnnnnnnn Enter the UNIQUE-ID and ensure the DOCUMENT CODE is not ‘00’
2.1 24 TAX YEAR
2.2 62 TIN (Requested TIN)
4.1 28 TOTAL OF ALL DOCUMENTS
7.1 8.1 9.1 2 DOCUMENT CODE
7.2 8.2 9.2 5 FORM Form Type
7.3 8.3 9.3 11 UNIQUE-ID
7.4 8.4 9.4 33 ALE
7.5 8.5 9.5 35 NAME FROM PART 1 OF FORM
7.6 8.6 9.6 74 INFORMATION STATUS INDICATORVALUES
P-Primary Document
D-Duplicate Document
C-Corrected By Another
V-Void By Another Document
B-Blank-No Value Supplied
7.7 8.7 9.7 78 DATA RECONCILIATION CODE (TBD)

Document Display Screen: 1094-B (Doc Code 11)

Form 1094-B Transmittal of Health Coverage Information Returns

This is an Image: 67908008.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 17 DOCUMENT CODE
1.7 31 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 11
3.1 17 DOCUMENT TYPE(1094-B)
3.2 43 ON FILE DATE MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 53 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL NAMES:
FILER DATA
4.2 22 FILER NINE-DIGIT (EIN) Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1
Thru
11.3
2 FILER’S DATA
NAME, ADDRESS, CITY, STATE, ZIP CODE, COUNTRY
(If foreign address, “STATE” is replaced with “CNTRY”, “ZIP” by “PLCD”, and “PROV’ will follow when appropriate.)
Box 1
Box 5
Box 6
Box 7
Box 8
5.2 58 LITERAL CONTACT INFO
6.2 44 CONTACT NAME Box 3
7.2 45 CONTACT TELEPHONE Box 4
20.1 11 TAX YEAR
20.2 37 FILED – RECEIVED ON
21.1 38 TOTAL 1095-B FORMS TRANSMITTED WITH FORM 1094-B. Box 9
22.1 38 TOTAL 1095-B FORMS PROCESSED
24.1 35 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of the individual document display.

Document Display Screen: 1094-C (Doc Code 12)

Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

This is an Image: 67908009.gif

Please click here for the text description of the image.

Note:

In Paper Form Reference column, Box numbers, when they appear, refer to the boxes on the paper forms.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE -
1.7 31 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 12
3.1 17 DOCUMENT TYPE(1094-C)
3.2 42 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 53 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL NAMES:
EMPLOYER DATA
4.2 22 EMPLOYER NINE-DIGIT (EIN) Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1
Thru
11.3
2 ALE DATA
NAME, ADDRESS, CITY, STATE, ZIP CODE, COUNTRY
(If foreign address, “STATE” is replaced with “CNTRY”, “ZIP” by “PLCD”, and “PROV’ will follow when appropriate.)
Box 1
Box 3
Box 4
Box 5
Box 6
5.2 58 LITERAL: CONTACT INFO
6.2 44 CONTACT NAME Box 7
7.2 45 CONTACT TELEPHONE Box 8
12.1 11 GOVERNMENT ENTITY DATA
12.2 27 EIN(Employer Identification Number) Box 10
13.1
Thru
19.3
2 DESIGNATED GOVERNMENT ENTITY NAME, ADDRESS,CITY,STATE,ZIP CODE, COUNTRY Box 9, 11-14
13.2 58 LITERAL: CONTACT INFO
14.1 2 CONTACT NAME Box 15
15.2 45 CONTACT TELEPHONE Box 16
20.1 11 TAX YEAR
20.2 37 FILED – RECEIVED ON
21.1 38 TOTAL 1095-C FORMS TRANSMITTED Box 18
22.1 38 TOTAL 1095-C FORMS PROCESSED
24.1 35 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of the individual document display.

Document Display Screen: 1094-C PART II (Doc Code 12)

Form 1094-C PART II Transmittal of Employer-Provided Health Insurance Offer

This is an Image: 67908019.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 12
3.1 17 DOCUMENT TYPE– (1094-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL NAMES:
EMPLOYER DATA
4.2 22 EIN Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 EMPLOYER NAME Box 1
12.1 42 AUTHORITATIVE TRANSMITTAL FOR THIS ALE from Box 19 of 1094-C
13.1 47 ALE MEMBER - A MEMBER OF AGGREGATED ALE GROUPfrom Box 21 of 1094-C
14.1 2 LITERAL: CERTIFICATIONS OF ELIGIBILITY
15.1 32 QUALIFYING OFFER METHOD Box 22a
16.1 50 RESERVED Box 22b
17.1 37 SECTION 4980H TRANSITION RELIEF Box 22c
18.1 22 98% OFFER METHOD Box 22d
21.1 38 TOTAL 1095-C FORMS FILED FOR ALE MEMBER Box 20
24.1 35 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of - the individual document display

Document Display Screen: 1094-C PART III (Doc Code 12)

Form 1094-C PART III Transmittal of Employer-Provided Health Insurance Offer

This is an Image: 67908010.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 12
3.1 17 DOCUMENT TYPE– (1094-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL EMPLOYER DATA
4.2 22 EIN Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 EMPLOYER NAME Box 1
9.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) ALL MONTHS
Yes, No, or Blank
Box 23a
9.2 27 AGG (AGGREGATED GROUP INDICATOR) ALL MONTHS
Yes or Blank
Box 23d
9.3 37 RELIEF (SECTION 4980H TRANSITION RELIEF INDICATOR) ALL MONTHS
A, B, or Blank
Box 23e
9.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) ALL MONTHS
Blank, Zero, or a Positive Number
Box 23b
9.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) ALL MONTHS
Blank, Zero, or a Positive Number
Box 23c
10.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) JAN
Yes, No, or Blank
Box 24a
10.2 27 AGG (AGGREGATED GROUP INDICATOR) JAN
Yes or Blank
Box 24d
10.3 37 RELIEF (SECTION 4980H TRANSITION RELIEF INDICATOR) JAN
A, B, or Blank
Box 24e
10.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) JAN
Blank, Zero, or Positive Number
Box 24b
10.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) JAN
Blank, Zero, or Positive Number
Box 24c
11.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) FEB
Yes, No, or Blank
Box 25a
11.2 27 AGG (AGGREGATED GROUP INDICATOR) FEB
Yes or Blank
Box 25d
11.3 37 RELIEF (SECTION 4980H TRANSITION RELIEF INDICATOR) FEB
A, B, or Blank
Box 25e
11.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) FEB
Blank, Zero, or Positive Number
Box 25b
11.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) FEB
Blank, Zero, or Positive Number
Box 25c
12.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) MAR
Yes, No, or Blank
Box 26a
12.2 27 AGG (AGGREGATED GROUP INDICATOR) MAR
Yes or Blank
Box 26d
12.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) MAR
A, B, or Blank
Box 26e
12.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) MAR
Blank, Zero, or Positive Number
Box 26b
12.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) MAR
Blank, Zero, or Positive Number
Box 26c
13.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) APR
Yes, No, or Blank
Box 27a
13.2 27 AGG (AGGREGATED GROUP INDICATOR) APR
Yes or Blank
Box 27d
13.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) APR
A, B, or Blank
Box 27e
13.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) APR
Blank, Zero, or Positive Number
Box 27b
13.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) APR
Blank, Zero, or Positive Number
Box 27c
14.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) MAY
Yes, No, or Blank
Box 28a
14.2 27 AGG (AGGREGATED GROUP INDICATOR) MAY
Yes or Blank
Box 28d
14.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) MAY
A, B, or Blank
Box 28e
14.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) MAY
Blank, Zero, or Positive Number
Box 28b
14.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) MAY
Blank, Zero, or Positive Number
Box 28c
15.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) JUN
Yes, No, or Blank
Box 29a
15.2 27 AGG (AGGREGATED GROUP INDICATOR) JUN
Yes or Blank
Box 29d
15.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) JUN
A, B, or Blank
Box 29e
15.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) JUN
Blank, Zero, or Positive Number
Box 29b
15.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) JUN
Blank, Zero, or Positive Number
Box 29c
16.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) JUL
Yes, No, or Blank
Box 30a
16.2 27 AGG (AGGREGATED GROUP INDICATOR) JUL
Yes or Blank
Box 30d
16.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) JUL
A, B, or Blank
Box 30e
16.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) JUL
Blank, Zero, or Positive Number
Box 30b
16.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) JUL
Blank, Zero, or Positive Number
Box 30c
17.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) AUG
Yes, No, or Blank
Box 31a
17.2 27 AGG (AGGREGATED GROUP INDICATOR) AUG
Yes or Blank
Box 31d
17.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) AUG
A, B, or Blank
Box 31e
17.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) AUG
Blank, Zero, or Positive Number
Box 31b
17.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) AUG
Blank, Zero, or Positive Number
Box 31c
18.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) SEP
Yes, No, or Blank
Box 32a
18.2 27 AGG (AGGREGATED GROUP INDICATOR) SEP
Yes or Blank
Box 32d
18.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) SEP
A, B, or Blank
Box 32e
18.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) SEP
Blank, Zero, or Positive Number
Box 32b
18.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) SEP
Blank, Zero, or Positive Number
Box 32c
19.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) OCT
Yes, No, or Blank
Box 33a
19.2 27 AGG (AGGREGATED GROUP INDICATOR) OCT
Yes or Blank
Box 33d
19.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) OCT
A, B, or Blank
Box 33e
19.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) OCT
Blank, Zero, or Positive Number
Box 33b
19.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) OCT
Blank, Zero, or Positive Number
Box 33c
20.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) NOV
Yes, No, or Blank
Box 34a
20.2 27 AGG (AGGREGATED GROUP INDICATOR) NOV
Yes or Blank
Box 34d
20.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) NOV
A, B, or Blank
Box34e
20.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) NOV
Blank, Zero, or Positive Number
Box34b
20.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) NOV
Blank, Zero, or Positive Number
Box 34c
21.1 13 MEC (MINIMUM ESSENTIAL COVERAGE OFFER INDICATOR) DEC
Yes, No, or Blank
Box 35a
21.2 27 AGG (AGGREGATED GROUP INDICATOR) DEC
Yes or Blank
Box 35d
21.3 37 RELIEF IND (SECTION 4980H TRANSITION RELIEF INDICATOR) DEC
A, B, or Blank
Box 35e
21.4 43 FTE (FULL-TIME EMPLOYEE COUNT FOR ALE MEMBER) DEC
Blank, Zero, or Positive Number
Box 35b
21.5 59 TOT EMP COUNT (TOTAL EMPLOYEE COUNT FOR ALE MEMBER) DEC
Blank, Zero, or Positive Number
Box 35c
24.1 35 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of - the individual document display

Document Display Screen: 1094-C PART IV (Doc Code 12)

Form 1094-C PART IV Transmittal of Employer-Provided Health Insurance Offer

This is an Image: 67908011.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 12
3.1 17 DOCUMENT TYPE– (1094-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL EMPLOYER DATA
4.2 27 EIN Box 2
4.2 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 EMPLOYER NAME Box 1
7.1 2 LITERAL OTHER ALE MEMBERS OF ALE GROUP
8.1, 8.2, 10.1, 10.2, 12.1, 12.2, 14.1, 14.2, 16.1, 16.2, 18.1, 18.2, 20.1, 20.2, 22.1, 22.2 2, 42 OTHER ALE MEMBERS OF ALE GROUP Box 36 - Box 65
9.1, 9.2, 11.1, 11.2, 13.1, 13.2, 15.1, 15.2, 17.1, 17.2, 19.1, 19.2, 21.1, 21.2, 23.1, 23.2 7, 47 EIN Box 36 - Box 65
24.1 35 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of - the individual document display

Document Display Screen: 1095-A (Doc Code 07)

Form 1095-A PART I RECIPIENT DATA

This is an Image: 67908012.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 07
3.1 17 DOCUMENT TYPE– (1095-A)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL RECIPIENT DATA
4.2 27 SSN Box 5
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 RECIPIENT’S DATA
Name, Address, city, State, Zip, and Country
BOXES 4, 12, 13, 14, 15
5.2 49 RECIPIENT’S DATE OF BIRTH (DOB) BOX 6
12 2 LITERAL SPOUSE DATA
12.2 27 SSN Box 8
13.1 2 SPOUSE NAME
(When no spouse information is on the form, “SPOUSE DATA: NONE” will appear. The following SSN, Name, DOB will not appear).
Box 7
13.2 49 SPOUSE’S DATE OF BIRTH (DOB) Box 9
15.1 26 MARKETPLACE IDENTIFIER Box 1
16.1 29 ASSIGNED POLICY NUMBER Box 2
17.1 25 POLICY ISSUER Box 3
18.1 24 POLICY START-DATE Box 10
19.1 30 POLICY TERMINATION-DATE Box 11
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-A PART II (Doc Code 07)

Form 1095-A PART II COVERAGE HOUSEHOLD.

This is an Image: 67908013.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 07
3.1 17 DOCUMENT TYPE– (1095-A)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL RECIPIENT DATA
4.2 27 SSN Box 5
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 RECIPIENT NAME Box 4
5.2 47 RECIPIENT DOB Box 6
7.1 2 LITERAL: COVERED INDIVIDUALS, SSN, DOB
8.1, 10.1, 12.1, 14.1, 16.1, 18.1, 20.1 2 COVERED INDIVIDUAL NAME Box 16a-20a
8.2, 10.2, 12.2, 14.2, 16.2, 18.2, 20.2 38 COVERED INDIVIDUAL SSN Box 16b-20b
8.3, 10.3, 12.3, 14.3, 16.3, 18.3, 20.3 52 COVERED INDIVIDUAL DOB Box 16c-20c
9.1, 11.1, 13.1, 15.1, 17.1, 19.1, 21.1 14 START DATE Box 10
9.2, 11.2, 13.2, 15.2, 17.2, 19.2, 21.2 44 TERMINATION-DATE Box 11
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-A PART III (Doc Code 07)

Form 1095-A PART III COVERAGE HOUSEHOLD

This is an Image: 67908020.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 07
3.1 17 DOCUMENT TYPE– (1095-A)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL NAME: RECIPIENT DATA
4.2 27 SSN Box 5
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 RECIPIENT NAME Box 4
5.2 49 RECIPIENT DOB Box 6
9.1 14 JAN PREMIUM AMOUNT Box 21a
9.2 30 JAN SECOND LOWEST COST SILVER PLAN (SLCSP) Box 21b
9.3 45 JAN MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 21c
10.1 14 FEB PREMIUM AMOUNT Box 22a
10.2 30 FEB SECOND LOWEST COST SILVER PLAN (SLCSP) Box 22b
10.3 45 FEB MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 22c
11.1 14 MAR PREMIUM AMOUNT Box 23a
11.2 30 MAR SECOND LOWEST COST SILVER PLAN (SLCSP) Box 23b
11.3 45 MAR MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 23c
12.1 14 APR PREMIUM AMOUNT Box 24a
12.2 30 APR SECOND LOWEST COST SILVER PLAN (SLCSP) Box 24b
12.3 45 APR MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 24c
13.1 14 MAY PREMIUM AMOUNT Box 25a
13.2 30 MAY SECOND LOWEST COST SILVER PLAN (SLCSP) Box 25b
13.3 45 MAY MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 25c
14.1 14 JUN PREMIUM AMOUNT Box 26a
14.2 30 JUN SECOND LOWEST COST SILVER PLAN (SLCSP) Box 26b
14.3 45 JUN MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 26c
15.1 14 JUL PREMIUM AMOUNT Box 27a
15.2 30 JUL SECOND LOWEST COST SILVER PLAN (SLCSP) Box 27b
15.3 45 JUL MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 27c
16.1 14 AUG PREMIUM AMOUNT Box 28a
16.2 30 AUG SECOND LOWEST COST SILVER PLAN (SLCSP) Box 28b
16.3 45 AUG MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 28c
17.1 14 SEP PREMIUM AMOUNT Box 29a
17.2 30 SEP SECOND LOWEST COST SILVER PLAN (SLCSP) Box 29b
17.3 45 SEP MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 29c
18.1 14 OCT PREMIUM AMOUNT Box 30a
18.2 30 OCT SECOND LOWEST COST SILVER PLAN (SLCSP) Box 30b
18.3 45 OCT MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 30c
19.1 14 NOV PREMIUM AMOUNT Box 31a
19.2 30 NOV SECOND LOWEST COST SILVER PLAN (SLCSP) Box 31b
19.3 45 NOV MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 31c
20.1 14 DEC PREMIUM AMOUNT Box 32a
20.2 30 DEC SECOND LOWEST COST SILVER PLAN (SLCSP) Box 32b
20.3 45 DEC MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 32c
22.1 10 TOTAL PREMIUM AMOUNT Box 33a
22.2 26 TOTAL SECOND LOWEST COST SILVER PLAN (SLCSP) Box 33b
22.3 41 TOTAL MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 33c
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-B (Doc Code 56)

Form 1095-B Responsible Individual (Policy Holder)

This is an Image: 67908014.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 56
3.1 17 DOCUMENT TYPE– (1095-B)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL RESPONSIBLE INDIVIDUAL DATA
4.2 27 SSN or TIN Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1
Thru
11.3
2 RESPONSIBLE INDIVIDUAL DATA
NAME, ADDRESS, CITY, STATE, ZIP CODE, COUNTRY

(If foreign address, “ STATE” is replaced with “CNTRY”, “ZIP” by “PLCD”, and “PROV” will follow when appropriate)

Box 1
Box 4
Box 5
Box 6
Box 7
5.2 49 RESPONSIBLE INDIVIDUAL’S DOB
(If SSN or other TIN is not available)
Box 3
12.1 2 LITERAL EMPLOYER DATA
12.2 27 EIN(Employer Identification Number Box 11
12.3 44 LITERAL ISSUER/PROVIDER
12.4 70 ISSUER/PROVIDER (EIN) Box 17
13.1, 14.1, 15.1, 16.1, 17.1, 18.1, 19.1, 19.219.3 2 EMPLOYER
NAME, ADDRESS,CITY,STATE,ZIP CODE, COUNTRY
Box 10
Box 12
Box 13
Box 14
Box 15
13.2, 14.2, 15.2, 16.2, 17.2, 18.2, 19.4, 19.5, 19.6 44 ISSUER/PROVIDER INFORMATION NAME, ADDRESS,CITY,STATE,ZIP CODE, COUNTRY Box 16
Box 19
Box 20
Box 21
Box 22
20 53 CONTACT TELEPHONE NUMBERTelephone number the individual seeking additional information may call. Box 18
21 14 SMALL BUSINESS HEALTH PROGRAM (S.H.O.P.) ID
22 20 ORIGIN OF POLICY
A. Small Business Health Options Program (SHOP).
B. Employer-sponsored coverage.
C. Government-sponsored program.
D. Individual market insurance.
E. Multiemployer plan.
F. Other Designated minimum essential coverage
Box 8
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-B PART II (Doc Code 56)

Form 1095-B Part II Covered Individual

This is an Image: 67908015.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.1 16 DOCUMENT CODE DC 56
3.1 17 DOCUMENT TYPE– (1095-B)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL RESPONSIBLE INDIVIDUAL DATA
4.2 27 RESPONSIBLE INDIVIDUAL
(SSN)of the responsible individual.
Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 RESPONSIBLE INDIVIDUAL NAME Box 1
5.2 47 RESPONSIBLE INDIVIDUAL DOB Box 3
7.1 2 LITERAL COVERED INDIVIDUALS:, SSN, DOB
8.1, 10.1, 12.1, 14.1, 16.1, 18.1, 20.1 2 COVERED INDIVIDUAL NAME
(If more than 7 names press enter to continue)
Box 23a
8.2, 10.2, 12.2, 14.2, 16.2, 18.2, 20.2 38 SSN or TIN Box 23b
8.3, 10.3, 12.3, 14.3, 16.3, 18.3, 20.3 50 DATE OF BIRTH (DOB)
(If SSN or other TIN is not available)
Box 23c
9.1, 11.1, 13.1, 15.1, 17.1, 19.1, 21.1 6 ALL
Check this box if all 12 months had coverage.
Box 23d
9.1, 11.1, 13.1, 15.1, 17.1, 19.1, 21.1 13,19,25,31,37, 43, 49, 55,61, 67, 73, 79 MONTHS
JAN, FEB ,MAR, APR, MAY, JUN, JUL, AUG, SEP, OCT, NOV, DEC
Box 23e
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-C (Doc Code 60)

Form 1095-C Employer-Provided Health Insurance Offer and Coverage

This is an Image: 67908016.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default..
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.3 16 DOCUMENT CODE DC 60
3.1 17 DOCUMENT TYPE– (1095-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL EMPLOYEE DATA
4.2 27 SOCIAL SECURITY NUMBER (SSN) Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1
Thru
11.3
2 EMPLOYEE DATA
NAME, ADDRESS, CITY, STATE, ZIP CODE, COUNTRY
(If foreign address, “STATE” is replaced with “CNTRY”, “ZIP” by “PLCD”, and “PROV’ will follow when appropriate).
Box 1
Box 3
Box 4
Box 5
Box 6
12.1 2 LITERAL EMPLOYER DATA
12.2 27 EIN(Employer Identification Number) Box 8
13.1
Thru
19.3
2 EMPLOYER NAME
ADDRESS
CITY
STATE
ZIP CODE
COUNTRY
Box7
Box 9
Box 11
Box 12
Box 13
13.2 54 CONTACT TELEPHONE Box 10
19.4 57 SELF-INSURED
Box checked if Self-Insured.
Box blank if not Self –Insured.
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-C PART II (Doc Code 60)

Form 1095-C Part II Employer-Provided Health Insurance Offer and Coverage

This is an Image: 67908017.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.2 16 DOCUMENT CODE DC 60
3.1 17 DOCUMENT TYPE– (1095-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL EMPLOYEE DATA
4.2 27 EMPLOYEE SSN NUMBER Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 EMPLOYEE NAME Box 1
7.1 2 LITERAL EMPLOYEE OFFER AND COVERAGE
8.1 20 PLAN START MONTH
9.1 13, 33, 58 LITERAL: OFFER COVERAGE, *LOWEST COST, EXCLUSION
10.1Thru22.1 18 OFFER COVERAGE
See Form 1095-C (2016)
Part II Line 14 Instructions
10.2Thru22.2 36 *LOWEST COST
See Form 1095-C (2016)
Part II Line 15 Instructions
10.2Thru22.2 61 EXCLUSION
See Form 1095-C (2016)
Part II Line 16 Instructions
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display

Document Display Screen: 1095-C Part III (Doc Code 60)

Form 1095-C Part III Employer-Provided Health Insurance Offer and Coverage

This is an Image: 67908018.gif

Please click here for the text description of the image.

LINE POSITION DESCRIPTION AND VALIDITY PAPER FORM REFERENCE
1.1 1 COMMAND CD
1.2 6 COMMAND DEFINER CD- “A”NOTE: Errors are treated as if you had entered the default.
1.3 7 REQUEST TIN -This Field recapitulates the requested TIN you entered
1.4 16 VALIDITY CODE -This Field recapitulates the VALIDITY CODE you entered.
1.5 17 TAX YEAR - Requested Tax Year
1.6 21 DOCUMENT CODE
1.7 32 CURRENT TAX YEAR
2.2 16 DOCUMENT CODE DC 60
3.1 17 DOCUMENT TYPE– (1095-C)
3.2 43 ON FILE DATE - MM/DD/YYYY
Date this document passed final valid format checks and became part of the IRDB. The document may not become available online immediately.
3.3 54 TYPE OF SUBMISSION:
CORRECTED/ORIGINAL
4.1 2 LITERAL EMPLOYEE DATA
4.2 27 EMPLOYEE SSN
(SSN)
Box 2
4.3 58 SUBMITTED TO IRS
‘PAPER’ or ‘ELECTRONICALLY’
5.1 2 EMPLOYEE NAME Box 1
7.1 2 LITERAL:COVERED INDIVIDUALS, SSN, DOB
8.1, 10.1, 12.1, 14.1, 16.1, 18.1, 20.1 2 COVERED INDIVIDUAL NAME
(If more than 8 names press enter to continue)
Box 23a
8.2, 10.2, 12.2, 14.2, 16.2, 18.2, 20.2 38 SOCIAL SECURITY NUMBER (SSN) Box 23b
8.3, 10.3, 12.3, 14.3, 16.3, 18.3, 20.3 50 DATE OF BIRTH (DOB) Box 23c
9.1, 11.1, 13.1, 15.1, 17.1, 19.1, 21.1 6 ALL
Check this box if all 12 months had coverage.
Box 23d
9.1, 11.1, 13.1, 15.1, 17.1, 19.1, 21.1 13,19,25,31,37,43,49,55,61,67,73,79 MONTHS
JAN,FEB,MAR,APR,MAY,JUN,JUL,AUG,SEP OCT,NOV,DEC
Box 23e
24 21 PAGE NUMBER OF TOTAL PAGES - The page number of the last document of— the individual document display