TOPS 1095B Continuation Sheet

Continuation sheet supplements the Affordable Care Act Tax Form to register health coverage with the Internal Revenue Service. This 1094-B Transmittal for 1095-B form includes prompts for covered individuals: name, social security number, date of birth and months of coverage. It is printed in black ink and is compatible with laser printers.

TOPS 1095B Continuation Sheet - 50 Sheet(s) - Legal - 11" x 8 1/2" Sheet Size - White Sheet(s) - Black Print Color - 50 / Pack