Instructions For Recipient, Instructions For Forms 1094-B And 1095-B

Where To File

Statements Furnished to Individuals

Send all information returns filed on paper to the following:

Filers of Form 1095-B must furnish a copy to the person

identified as the responsible individual named on the form.

If your principal business,

On Form 1095-B statements furnished to recipients,

office or agency, or legal

filers of Form 1095-B may truncate the SSN (or other TIN,

Use the following address:

residence in the case of an

if applicable) of an individual receiving coverage by

individual, is located in:

showing only the last four digits of the SSN (or other TIN)

and replacing the first five digits with asterisks (*) or Xs.

▼

Truncation is not allowed on forms filed with the IRS.

Alabama, Arizona, Arkansas,

Similarly, the filer’s employer identification number (EIN)

Connecticut, Delaware, Florida,

may be truncated on the statements furnished to

Georgia, Kentucky, Louisiana,

individuals but not on forms filed with the IRS.

Maine, Massachusetts,

Department of the Treasury

Statements must be furnished on paper by mail, unless

Mississippi, New Hampshire,

Internal Revenue Service

the recipient affirmatively consents to receive the

New Jersey, New Mexico, New

Center

statement in an electronic format. If mailed, the statement

York, North Carolina, Ohio,

Austin, TX 73301

must be sent to the recipient’s last known permanent

Pennsylvania, Rhode Island,

address, or if no permanent address is known, to the

Texas, Vermont, Virginia,

recipient’s temporary address.

West Virginia

Consent to furnish statement electronically. The

Alaska, California, Colorado,

requirement to obtain affirmative consent to furnish a

District of Columbia, Hawaii,

statement electronically ensures that statements are sent

Idaho, Illinois, Indiana, Iowa,

electronically only to individuals who are able to access

Kansas, Maryland, Michigan,

Department of the Treasury

them. A recipient may consent on paper or electronically,

Minnesota, Missouri, Montana,

Internal Revenue Service

such as by e-mail. If consent is on paper the recipient

Nebraska, Nevada, North

Center

must confirm the consent electronically. A statement may

Dakota, Oklahoma, Oregon,

Kansas City, MO 64999

be furnished electronically by e-mail or by informing the

South Carolina, South Dakota,

recipient how to access the statement on the filer’s

Tennessee, Utah, Washington,

website.

Wisconsin, Wyoming

Specific Instructions for Form 1094-B

Line 1. Enter the filer’s complete name.

If your legal residence or principal place of business or

principal office or agency is outside the United States, file

Line 2. Enter the filer’s nine-digit (EIN). If you do not have

with the Department of the Treasury, Internal Revenue

an EIN, you may apply for one online. Go to IRS.gov and

Service Center, Austin, TX 73301.

enter “EIN” in the search box. You may also apply by

How To File

faxing or mailing Form SS-4, Application for Employer

Identification Number, to the IRS. See the Instructions for

Form SS-4 for more information. See Publication 1635,

Form 1094-B and Form

Employer Identification Number, for further information.

1095-B are subject to the

requirement to file returns

Lines 3 & 4. Enter the name and telephone number,

electronically. Filers of 250 or more information returns

including area code, of the person to contact who is

(Forms 1095-B) must file Forms 1094-B and 1095-B

responsible for answering any questions.

electronically. The 250-or-more requirement applies

Lines 5-8. Enter the filer’s complete address where all

separately to each type of return and separately to each

correspondence will be sent. If mail is delivered to a P.O.

type of corrected return. Filers of fewer than 250 returns

Box and not a street address enter the box number

may file electronically or on paper.

instead of the street address.

Publication 5165, Affordable Care Act (ACA) Information

Line 9. Enter the total number of Forms 1095-B that are

Returns (AIR) Guide for Software Developers and

transmitted with Form 1094-B.

Transmitters, currently under development, will outline the

communication procedures, transmission formats,

Specific Instructions for Form 1095-B

business rules and validation procedures for returns filed

electronically through the AIR system. To develop

Part I—Responsible Individual (Policy Holder)

software for use with the AIR system, transmitters and

software developers should use the guidelines provided in

Line 1. Enter the name of the responsible individual. A

Publication 5165 along with the Extensible Markup

responsible individual may be a primary insured

Language (XML) Schemas published on IRS.gov. See

employee, former employee, parent, uniformed services

Publication 5165 for more information.

sponsor, or other person enrolling individuals in coverage.

Do not enter the name of a business or business owner

You will receive an electronic acknowledgment once you

that is the policy holder for its employees.

complete the transaction. Keep it with your records.

Line 2. Enter the nine-digit social security number (SSN)

Corrected Forms 1094-B and 1095-B

of the responsible individual (111-11-1111). Enter a

Reserved.

taxpayer identification number (TIN), rather than an SSN,

if the responsible individual does not have an SSN. No

SSN or other TIN is required if the responsible individual

is not a covered individual identified in Part IV. See

-3-

Instructions for Forms 1094-B and 1095-B 2014

Instructions For Recipient, Instructions For Forms 1094-B And 1095-B - 2014 Page 4

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