2.3.86 Command Code IRPOL

Manual Transmittal

January 19, 2018

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) IRM 2.3.86 has been revised to include Program, Scope, and Objectives.

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

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

(4) 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

N/A

Audience

IDRS USERS, SB/SE.

Effective Date

(01-31-2018)

S. Gina Garza
Chief Information Officer

Program Scope and Objectives

  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 (TY2017, TY2016, TY2015, or TY2014).

Important Dates For Command Code IRPOL

  1. TY 2017 data should be accessible online on Wednesday, January 31, 2018.

Command Code IRPOL Valid Tax Years

  1. Four tax years (TY2014, TY2015, TY2016, or TY2017) 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 FORM DOC CODE TY2014 TY2015 TY2016 TY2017
1094-B 11 X X X X
1094-C 12 X X X X
1095-A 07 X X X X
1095-B 56 X X X X
1095-C 60 X 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 See IRM 2.3.86-1  
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
See IRM 2.3.86-1
 
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
Y or N
See Table Below
DATA RECONCILIATION CODES
Aggregated Group Indicator
Rule Description Interpretation of Data
A01 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated Group Indicator marked for "All 12 Months". Consider Aggregated Group Indicator "All 12 Months" field marked
A02 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated Group Indicator marked for "All 12 Months". Consider Aggregated Group Indicator "All 12 Months" field marked
A03 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A04 A05 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A06 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked for only monthly fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked monthly. Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator monthly fields marked
A07 A37 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A08 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A09 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A10 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A11 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as both Yes and No and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A12 A13 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked for both monthly field and "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A14 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A15 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked monthly. Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator monthly fields marked
A16 A17 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A18 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A19 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A20 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as No and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A21 A22 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked for both monthly field and "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A23 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A24 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked monthly. Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator monthly fields marked
A25 A26 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list contains at least one entry, then consider Aggregated ALE Group membership as Yes with Aggregated Group Indicator marked for "All 12 Months". Consider Member of Aggregated ALE Group is marked as Yes with Aggregated Group Indicator "All 12 Months" marked
A27 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A28 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A29 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A30 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is unmarked and Aggregated Group Indicator has been unmarked for all fields and Other Members of Aggregated Group member list is empty, then consider Aggregated ALE Group membership as No. Consider Member of Aggregated ALE Group is marked as No
A31 When Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been marked only for "All 12 Months" and Other Members of Aggregated Group member list has no entries, then consider Aggregated Group Indicator marked for "All 12 Months" and consider as Other ALE Members have 30 membersMonths" and Other Members of Aggregated Group member list has no entries, then consider Aggregated Group Indicator marked for "All 12 Months" and consider as Other ALE Members have 30 members. Consider Aggregated Group Indicator "All 12 Months" marked and consider 30 members in metadata
A32 A33 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been marked for both monthly fields and "All 12 Months" and Other Members of Aggregated Group member list has no entries, then consider Aggregated Group Indicator marked for "All 12 Months" and consider as Other ALE Members have 30 members Consider Aggregated Group Indicator "All 12 Months" marked and consider 30 members in metadata
A34 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been marked only for monthly fields and Other Members of Aggregated Group member list has no entries, then consider Aggregated Group Indicator marked monthly and consider as Other ALE Members have 30 members. Consider Aggregated Group Indicator months marked and consider 30 members in metadata
A35 A36 When evaluating for data consistency of the 1094C form, when Aggregated ALE Group membership is marked as Yes and Aggregated Group Indicator has been unmarked for all monthly fields and "All 12 Months" and Other Members of Aggregated Group member list has no entries, then consider Aggregated Group Indicator marked for "All 12 Months" and consider as Other ALE Members have 30 members. Consider Aggregated Group Indicator "All 12 Months" marked and leave unmarked for all monthly fields and consider 30 members in metadata
     
Minimum Essential Coverage (MEC) offer indicator
Rule Description Interpretation of Data
B01 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as either Yes or No and all monthly rows have been marked as either Yes or No, then consider all monthly MEC indicator rows. Consider monthly MEC offer indicator
B02 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been unmarked and all monthly rows have been unmarked, then consider all monthly rows with MEC not offered and all values marked as No. Consider all derived MEC monthly values as No
B03 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as both Yes and No and all monthly rows have been marked as either Yes or No, then consider all monthly MEC indicator rows. Consider monthly MEC offer indicator
B04 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been as both Yes and No and all monthly rows have been unmarked, then consider all monthly rows with MEC not offered and all values marked as No. Consider MEC not offered yearly with value marked as No
B05 B06 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as either Yes or No and some monthly rows have been marked as either Yes or No and other rows have been either left unmarked or marked as both Yes and No, then consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No. Consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No
B06 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been unmarked and some monthly rows have been marked as either Yes or No and other rows have been either left unmarked or marked as both Yes and No, then consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No. Consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No
B07 B08 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as both Yes and No and some monthly rows have been marked as either Yes or No and other rows have been either left unmarked or marked as both Yes and No, then consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No. Consider MEC offered by month with original values and for fields that were marked Yes and No simultaneously or left blank consider them marked as No
B09 B10 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as either Yes or No and all monthly rows have been either unmarked or marked as both Yes and No, then consider all monthly rows with MEC not offered and all values marked as No. Consider MEC offered by month with all values marked No
B11 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been unmarked and all monthly rows have been either unmarked or marked as both Yes and No, then consider all monthly rows with MEC not offered and all values marked as No. Consider MEC offered by month with all values marked No
B12 B13 When evaluating for data consistency of the 1094C form, when Minimal Essential Coverage Offer Indicator (MEC) value for "All 12 Months" has been marked as both Yes and No and all monthly rows have been either unmarked or marked as both Yes and No, then consider all monthly rows with MEC not offered and all values marked as No. Consider MEC offered by month with all values marked No
     
FTE - Part III column (b), Form 1094-C
Rule Description Interpretation of Data
C01 When evaluating for data consistency of the 1094C form, when Full Time Employee (FTE) Count has a value zero or greater than zero for "All 12 Months" and all monthly rows have values greater than zero, then consider monthly values. Consider FTE count by month and use monthly value.
C02 When evaluating for data consistency of the 1094C form, when Full Time Employee (FTE) Count has a value greater than zero for "All 12 Months" and all monthly rows have value zero, then consider FTE count of All 12 months value Consider FTE count of All 12 months and replace all monthly rows with value zero to blank.
C03 When evaluating for data consistency of the 1094C form, when Full Time Employee (FTE) Count has a value greater than zero for "All 12 Months" and some monthly rows have value zero and the rest have blank, then consider FTE count of All 12 months value Consider FTE count of All 12 months and replace all monthly rows with value zero to blank.
C04 C05 When evaluating for data consistency of the 1094C form, when Full Time Employee (FTE) Count has a value zero or greater than zero or blank for "All 12 Months" and some but not all monthly rows have values greater than zero, then consider monthly values as marked and consider highest monthly value for all empty monthly fields. Consider highest monthly value to mark empty FTE fields and consider FTE count by month
     
FTE per Number of Total 1095-Cs filed (Line 20) on 1094-C
Rule Description Interpretation of Data
D01 D02 When evaluating for data consistency of the 1094C form, if Box D on line 22 is not checked and Full Time Employee (FTE) Count has a value zero or blank for "All 12 Months" and all monthly rows have either zero or blank , then all monthly values will use the greater than zero value contained in Total Number of Forms 1095C filed by ALE Member. Consider Total Number of Form 1095C filed by and/or on behalf of ALE Member count to update all monthly values and consider FTE count by month
     
FTE per Total number of 1095-Cs recorded in IRDB
Rule Description Interpretation of Data
E01 E02 When evaluating for data consistency of the 1094C form, if Box D on line 22 is not checked and Full Time Employee (FTE) Count has a value zero or blank for "All 12 Months" and all monthly rows have either zero or blank and Total Number of Forms 1095C filed by ALE Member has a value zero or blank ,then use total number of Form1095C for the EIN from IRDB data tables count to update for all monthly values. Consider the total number of Form 1095-C for that EIN from the IRDB data tables count to update all monthly values and consider FTE count by month
     
Transition Relief
Rule Description Interpretation of Data
F01 F02 When evaluating for data consistency of the 1094C form, when transition relief code is valid for "All 12 Months" and valid for at least one monthly row, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes mark value as blank
F03 F04 When evaluating for data consistency of the 1094C form, when transition relief code is invalid for "All 12 Months" and valid for at least one monthly row, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes mark value as blank
F05 When evaluating for data consistency of the 1094C form, when transition relief code is blank for "All 12 Months" and valid for at least one monthly row, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes mark value as blank
F06 F07 When evaluating for data consistency of the 1094C form, when transition relief code is valid for "All 12 Months" and invalid for all monthly rows, then consider the "All 12 months" value as valid and for any invalid monthly codes mark value as blank. Consider the valid All 12 months value and change invalid monthly values to blank
F08 F09 When evaluating for data consistency of the 1094C form, when transition relief code is invalid for "All 12 Months" and invalid for all monthly rows, then consider not qualified for 4980H relief and for any invalid codes mark value as blank. Consider monthly relief fields as not valid and for any invalid codes mark value as blank
F10 When evaluating for data consistency of the 1094C form, when transition relief code is invalid for "All 12 Months" and blank for all monthly rows, then consider not qualified for 4980H relief and for any invalid codes mark value as blank. Consider yearly relief field as not valid and for any invalid codes mark value as blank
F11 When evaluating for data consistency of the 1094C form, when transition relief code is blank for "All 12 Months" and invalid for all monthly rows, then consider not qualified for 4980H relief and for any invalid codes mark value as blank. Consider monthly relief fields as not valid and for any invalid codes mark value as blank
     
MEC offer Code (Line 14), Form 1095-C
Rule Description Interpretation of Data
G01 G02 When evaluating for data consistency of the 1095C form, when coverage code is valid for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
G03 G04 When evaluating for data consistency of the 1095C form, when coverage code is invalid for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
G05 When evaluating for data consistency of the 1095C form, when coverage code is blank for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
G06 G07 When evaluating for data consistency of the 1095C form, when coverage code is valid for "All 12 Months" and invalid for all monthly values, then consider "All 12 months" value as valid and for any invalid monthly codes mark value as blank. Consider the valid All 12 months value and change invalid monthly values to blank
G08 G09 When evaluating for data consistency of the 1095C form, when coverage code is invalid for "All 12 Months" and invalid for all monthly values, then consider coverage as not valid and for any invalid codes mark value as blank. Consider monthly coverage fields as not valid and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
G10 When evaluating for data consistency of the 1095C form, when coverage code is invalid for "All 12 Months" and blank for all monthly values, then consider coverage as not valid and for any invalid codes mark value as blank. Consider yearly coverage field as not valid and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
G11 When evaluating for data consistency of the 1095C form, when coverage code is blank for "All 12 Months" and invalid for all monthly values, then consider coverage as not valid and for any invalid codes mark value as blank. Consider monthly coverage fields as not valid and for any invalid codes found change invalid value to blank Note: for this rule if a monthly value is changed to blank it is treated as if no offer was made.
     
Safe Harbors and Other Relief (Line 16), Form 1095-C
Rule Description Interpretation of Data
H01 H02 When evaluating for data consistency of the 1095C form, when relief code is valid for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank
H03 H04 When evaluating for data consistency of the 1095C form, when relief code is invalid for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank
H05 When evaluating for data consistency of the 1095C form, when relief code is blank for "All 12 Months" and valid for at least one monthly value, then consider valid monthly values and for any invalid codes mark value as blank. Consider valid monthly values and for any invalid codes found change invalid value to blank
H06 H07 When evaluating for data consistency of the 1095C form, when relief code is valid for "All 12 Months" and invalid for all monthly values, then consider "All 12 months" value as valid and for any invalid monthly codes mark value as blank. Consider the valid All 12 months value and change invalid monthly values to blank
H08 H09 When evaluating for data consistency of the 1095C form, when relief code is invalid for "All 12 Months" and invalid for all monthly values, then consider monthly relief code as not valid and for any invalid codes mark value as blank. Consider monthly relief fields as not valid and for any invalid codes found change invalid value to blank
H10 When evaluating for data consistency of the 1095C form, when relief code is invalid for "All 12 Months" and blank for all monthly values, then consider yearly relief code as not valid and for any invalid codes mark value as blank. Consider yearly relief field as not valid and for any invalid codes found change invalid value to blank
H11 When evaluating for data consistency of the 1095C form, when relief code is blank for "All 12 Months" and invalid for all monthly values, then consider monthly relief code as not valid and for any invalid codes mark value as blank. Consider monthly relief fields as not valid and for any invalid codes found change invalid value to blank

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
See IRM 2.3.86-1
 
1.6 17 DOCUMENT CODE  
1.7 31 REQUESTED 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
See IRM 2.3.86-1
 
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 REQUESTED 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 REQUESTED 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 Box19
13.1 47 ALE MEMBER - A MEMBER OF AGGREGATED ALE GROUP Box 21
14.1 2 LITERAL: CERTIFICATIONS OF ELIGIBILITY  
15.1 32 QUALIFYING OFFER METHOD Box 22a
16.1 50 RESERVED Box 22b
( TY2016-TY2017)
17.1 37 RESERVED Box 22c
RESERVED ( TY2017)
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 REQUESTED 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 REQUESTED 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: 1094-C Data Reconciliation Code (Doc Code 12)

Form 1094-C Data Reconciliation Code-Transmittal of Employer-Provided Health Insurance Offer.

This is an Image: 67908021.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 REQUESTED 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
 
6.1 2 DATA RECONCILIATION CODES FOR AGGREGATED GROUP INDICATORS (Potentially codes A01 thru A26 can be listed)  
9.1 2 DATA RECONCILATION CODES FOR MINIMUM ESSENTIAL COVERAGE (MEC) OFFER INDICATORS (Potentially code B04 can be listed) Box 2
12.1 2 DATA RECONCILIATION CODES FOR FTE – PART III COLUMN B, FORM 11094-C INDICATORS (Potentially codes C01 and/or C03 can be listed)  
15.1 2 DATA RECONCILIATION CODES FOR FTE PER NUMBER OF TOTAL 1095-CS FILED (LINE 20) ON 1094-C (Potentially D01 code can be listed)  
18.1 2 DATA RECONCILIATION CODES FOR FTE PER TOTAL NUMBER OF 1095-CS RECORDED IN IRDB (Potentially E01 code can be listed)  
21.1 2 DATA RECONCILIATION CODES FOR TRANSITION RELIEF INDICATORS (Potentially codes F01, F06, F07 can be listed)  
23.1 2 EXHIBIT 2.3.86.2 JOB AIDE EXHIBIT  

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

Form 1095-A PART I Health Insurance Marketplace Statement.

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 REQUESTED 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 Health Insurance Marketplace Statement.

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 REQUESTED 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 COVERAGE START DATE Boxes16D-20D
9.2, 11.2, 13.2, 15.2, 17.2, 19.2, 21.2 44 COVERAGE TERMINATION DATE Boxes 16E-20E
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 Health Insurance Marketplace Statement

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 REQUESTED 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
7.1 12 LITERAL NAME: ENROLLMT  
7.2 29 LITERAL NAME: SLCSP  
7.3 46 LITERAL NAME: APCT  
8.1 13 LITERAL NAME: PREM  
8.2 30 LITERAL NAME: AMT  
8.3 46 LITERAL NAME:AMT  
9.1 14 JAN MONTHLY PREMIUM AMOUNT Box 21a
9.2 30 JAN MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 22a
10.2 30 FEB MONTHLY 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 MONTHLY AMOUNT Box 23a
11.2 30 MAR MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 24a
12.2 30 APR MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 25a
13.2 30 MAY MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 26a
14.2 30 JUN MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 27a
15.2 30 JUL MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 28a
16.2 30 AUG MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 29a
17.2 30 SEP MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 30a
18.2 30 OCT MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 31a
19.2 30 NOV MONTHLY 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 MONTHLY PREMIUM AMOUNT Box 32a
20.2 30 DEC MONTHLY SECOND LOWEST COST SILVER PLAN (SLCSP) Box 32b
20.3 45 DEC MONTHLY ADVANCE PAYMENT OF PREMIUM TAX CREDIT Box 32c
22.1 10 ANNUAL TOTAL MONTHLY PREMIUM AMOUNT Box 33a
22.2 26 TOTAL MONTHLY 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 Health Coverage (Responsible Individual)

This is an Image: 67908014.gif
 

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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 REQUESTED 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 Note: This line is reserve for TY2016 and TY2017
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 Health Coverage (Employee-Sponsored Coveragel)

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 REQUESTED 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 REQUESTED 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 not checked if not Self –Insured.
Part III
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

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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 REQUESTED 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 (2017)
Part II Line 14 Instructions
10.2Thru22.2 36 *LOWEST COST
See Form 1095-C (2017)
Part II Line 15 Instructions
10.2Thru22.2 61 EXCLUSION
See Form 1095-C (2017)
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 REQUESTED 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  

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

Form 1095-C Data Reconciliation Code- Employer-Provided Health Insurance Offer and Coverage

This is an Image: 67908022.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 REQUESTED TAX YEAR  
2.1 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
 
6.1 2 DATA RECONCILIATION CODES FOR OFFER OF COVERAGE CODE (LINE 14), FORM 1095-C INDICATORS (Potentially codes G01, G04,G05,G06 can be listed)  
9.1 2 DATA RECONCILATION CODES FOR SAFE HARBOR AND OTHER RELIEF (LINE 16), FORM 1095-C INDICATORS (Potentially code H01, H04, H06 can be listed) Box 2
23.1 2 EXHIBIT 2.3.86.2 JOB AIDE EXHIBIT