Instructions For Forms 1094-C And 1095-C - 2017 (Page 17 of 17) in pdf

dependents regardless of the actual number of dependents, if

Privacy Act and Paperwork Reduction Act Notice. We ask

any, an employee has during any particular calendar month.

for the information on these forms to carry out the Internal

An ALE Member offers health coverage for a month only if it

Revenue laws of the United States and the Patient Protection

offers health coverage that would provide coverage for every

and Affordable Care Act. Our legal right to ask for the

day of that calendar month. For reporting purposes, this means

information on this form is Internal Revenue Code sections 6055,

that an offer of coverage does not occur for a month if an

6056, 4980H and their regulations. We request it to confirm that

employee’s employment terminates before the last day of a

you are providing your employees offers of, and enrollment in,

calendar month and the health coverage also ends before the

health coverage and to determine the employer shared

last day of that calendar month (or for an employee who did not

responsibility payments and eligibility of your employees for

enroll in coverage, the coverage would have ended if the

premium tax credits. If you do not provide this information, we

employee had enrolled in coverage). However, see the

may be unable to determine whether your employees are

description of Code Series 2—Section 4980H Safe Harbor

entitled to premium tax credits. Providing false or fraudulent

Codes and Other Relief for Employers, code 2B which may be

information may subject you to penalties. We may disclose this

applicable in these circumstances to indicate that the ALE

information to the Department of Justice for civil or criminal

Member is treated as having offered coverage for the entire

litigation and to cities, states, and the District of Columbia for use

month for purposes of section 4980H.

in administering their tax laws. We may also disclose this

An ALE Member offers health coverage to an employee if it,

information to other countries under a tax treaty, to Federal and

or another employer in the Aggregated ALE Group, or a third

state agencies to enforce Federal nontax criminal laws, or to

party such as a multiemployer or single employer Taft-Hartley

Federal law enforcement and intelligence agencies to combat

plan, a multiple employer welfare arrangement (MEWA), or, in

terrorism.

certain cases, a staffing firm, offers health coverage on behalf of

You are not required to provide the information requested on

the employer. See Regulations sections 54.4980H-4(b)(2) and

a form that is subject to the Paperwork Reduction Act unless the

54.4980H-5(b).

form displays a valid OMB control number. Books or records

Interim Guidance Regarding Multiemployer

relating to a form or its instructions must be retained as long as

Arrangements. An ALE Member is treated as offering

their contents may become material in the administration of any

TIP

health coverage to an employee if the ALE Member is

Internal Revenue law. Generally, tax returns and return

required by a collective bargaining agreement or related

information are confidential, as required by section 6103.

participation agreement to make contributions for that employee

The time needed to complete and file this form will vary

to a multiemployer plan that offers, to individuals who satisfy the

depending on individual circumstances. The estimated average

plan’s eligibility conditions, health coverage that is affordable

time is:

and provides minimum value, and that also offers health

coverage to those individuals’ dependents. For more

information, see section XV.E of the preamble to the final

Form 1094–C

4 hrs.

. . . . . . . . . . . . . . .

regulations under section 4980H. This relief is referred to as the

Form 1095–C

12 min.

. . . . . . . . . . . . . . .

multiemployer arrangement interim guidance and the

multiemployer interim rule relief in these instructions.

Qualifying Offer. A Qualifying Offer is an offer of MEC

If you have comments concerning the accuracy of these time

providing minimum value to one or more full-time employees for

estimates or suggestions for making this form simpler, we would

all calendar months during the calendar year for which the

be happy to hear from you. You can send us comments from

employee was a full-time employee for whom a section 4980H

IRS.gov/FormComments. Or you can write to the Internal

assessable payment could apply, with an Employee Required

Revenue Service, Tax Forms and Publications Division, 1111

Contribution for each month not exceeding 9.5 % (as adjusted)

Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't

of the mainland single federal poverty line divided by 12,

send the form to this office.

provided that the offer includes an offer of MEC to the

employee’s spouse and dependents (if any).

-17-

Instructions for Forms 1094-C and 1095-C (2017)

Instructions For Forms 1094-C And 1095-C - 2017 Page 17

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