Form 1094 B PDF Details

Understanding the Form 1094-B is fundamental for entities navigating the complexities of reporting health coverage information to the Internal Revenue Service (IRS). This document serves as the transmittal form that accompanies form 1095-B, crucial for entities required to report information on health insurance coverage offered to individuals. The 2021 version, as outlined by the Department of the Treasury, highlights key information including the filer's name, employer identification number (EIN), contact details, and the address of the filer. By facilitating the submission of these forms, the IRS aims to streamline the enforcement of health insurance coverage mandates. Moreover, the declaration section underscores the importance of accuracy and truthfulness in the submission, as it is subject to penalties of perjury. Entities must ensure completeness and correctness to comply with federal regulations, making it essential to be well-informed about the intricacies and responsibilities entailed in Form 1094-B. The instructions and latest updates can be accessed through the IRS website, reinforcing the need for continuous engagement with current guidelines to ensure compliance.

QuestionAnswer
Form NameForm 1094 B
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescity or ... - IRS tax forms, street address, PAYERS name

Form Preview Example

110116

Form 1094-B

 

Transmittal of Health Coverage Information Returns

 

 

 

 

 

 

 

 

 

 

 

OMB No. 1545-2252

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2021

 

 

 

 

Department of the Treasury

 

▶ Go to WWW.IRS.GOV/FORM1094B for instructions and the latest information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Internal Revenue Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Filer's name

 

 

2 Employer identification number (EIN)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Name of person to contact

 

 

4 Contact telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5

Street address (including room or suite no.)

 

6 City or town

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For Official Use Only

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7

State or province

 

8 Country and ZIP or foreign postal code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9 Total number of Forms 1095-B submitted with this transmittal . . . . . . . . . . . . . . ▶

Under penalties of perjury, I declare that I have examined this return and accompanying documents, and to the best of my knowledge and belief, they are true, correct, and complete.

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Signature

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Title

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Date

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 61570P

Form 1094-B (2021)

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PAYERS name completion process clarified (portion 1)

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