Instructions for IRS Form 1094-c, Form 1095-c 2017

September 7, 2017 "Instructions For Forms 1094-c And 1095-c" contain the latest filing requirements for the IRS-issued Form 1095-c. Download your copy of the instructions by clicking the link below.

IRS Form 1095-c is tax form released and collected by the Internal Revenue Service of the United States.

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2017
Department of the Treasury
Internal Revenue Service
Instructions for Forms
1094-C and 1095-C
Purpose of Form
Section references are to the Internal Revenue Code unless
otherwise noted.
Employers with 50 or more full-time employees (including
Future Developments
full-time equivalent employees) in the previous year use Forms
1094-C and 1095-C to report the information required under
For the latest information about developments related to Form
sections 6055 and 6056 about offers of health coverage and
1094-C, Transmittal of Employer-Provided Health Insurance
enrollment in health coverage for their employees. Form 1094-C
Offer and Coverage Information Returns, and Form 1095-C,
must be used to report to the IRS summary information for each
Employer-Provided Health Insurance Offer and Coverage, and
ALE Member and to transmit Forms 1095-C to the IRS. Form
instructions, such as legislation enacted after they were
1095-C is used to report information about each employee to the
published, go to
IRS.gov/form1094c
and IRS.gov/form1095c.
IRS and to the employee. Forms 1094-C and 1095-C are used in
What's New
determining whether an ALE Member owes a payment under the
employer shared responsibility provisions under section 4980H.
Form 1095-C is also used in determining the eligibility of
Section 4980H transition relief. Several forms of transition
employees for the premium tax credit.
relief were available to some employers under section 4980H for
2016. No section 4980H transition relief is available for 2017.
ALE Members that offer employer-sponsored self-insured
Therefore, these instructions have been revised to remove
coverage also use Form 1095-C to report information to the IRS
discussion of section 4980H transition relief, and Form 1094-C
and to employees about individuals who have minimum
has also been revised. Specifically, Form 1094-C, line 22, box C
essential coverage under the employer plan and therefore are
is designated “Reserved”; Part III, column (e) is designated
not liable for the individual shared responsibility payment for the
“Reserved”; and the entry rows in Part III, column (e) are shaded.
months that they are covered under the plan.
Additional Information
Who Must File
For information related to the Affordable Care Act, visit
An ALE Member must file one or more Forms 1094-C (including
www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home. For
a Form 1094-C designated as the Authoritative Transmittal,
the final regulations under section 6056, Information Reporting
whether or not filing multiple Forms 1094-C), and must file a
by Applicable Large Employers on Health Insurance Coverage
Form 1095-C for each employee who was a full-time employee
Offered Under Employer-Sponsored Plans, see T.D. 9661,
of the ALE Member for any month of the calendar year.
2014-13 I.R.B. 855, at www.irs.gov/irb/2014-13_IRB/ar09.html.
Generally, the ALE Member is required to furnish a copy of the
For the final regulations under section 6055, Information
Form 1095-C (or a substitute form) to the employee.
Reporting of Minimum Essential Coverage, see T.D. 9660,
2014-13 I.R.B.842, at www.irs.gov/irb/2014–13_IRB/ar08.html.
An ALE Member is, generally, a single person or entity that is
For the final regulations under section 4980H, Shared
an Applicable Large Employer, or if applicable, each person or
Responsibility for Employers Regarding Health Coverage, see
entity that is a member of an Aggregated ALE Group. An
T.D. 9655, 2014-9 I.R.B. 541, at
www.irs.gov/irb/2014-9_IRB/
Applicable Large Employer, generally, is an employer with 50 or
ar05.html. For answers to frequently asked questions regarding
more full-time employees (including full-time equivalent
the employer shared responsibility provisions and related
employees) in the previous year. For purposes of determining if
information reporting requirements, visit IRS.gov.
an employer or group of employers is an Applicable Large
Employer, all ALE Members under common control (an
For information related to filing Forms 1094-C and 1095-C
Aggregated ALE Group) are aggregated together. If the
electronically visit
www.irs.gov/e-file-providers/air/affordable-
Aggregated ALE Group, taking into account the employees of all
care-act-information-return-air-program. For FAQs specifically
ALE Members in the group, employed on average 50 or more
related to completing Forms 1094-C and 1095-C, go to
full-time employees (including full-time equivalent employees)
www.irs.gov/Affordable-Care-Act/Employers/Questions-and-
on business days during the preceding calendar year, then the
Answers-about-Information-Reporting-by-Employers-on-
Aggregated ALE Group is an Applicable Large Employer and
Form-1094-C-and-Form-1095-C.
each separate employer within the group is an ALE Member.
For additional guidance and proposed regulatory changes
Each ALE Member is required to file Forms 1094-C and 1095-C
relating to section 6055, including clarifications regarding the
reporting offers of coverage to its full-time employees (even if the
reporting requirements for providers of minimum essential
ALE Member has fewer than 50 full-time employees of its own).
coverage and the requirement to solicit the TIN of each covered
For more information on which employers are subject to the
individual for purposes of the reporting of health coverage
employer shared responsibility provisions of section 4980H, see
information, see Proposed Regulations section 1.6055-1(h) and
Employer
in the Definitions section of these instructions. For
Regulations section 301.6724-1.
more information on determining full-time employees, see
General Instructions for
Full-Time Employee
in the Definitions section of these
instructions, which includes information on the treatment of new
Forms 1094-C and 1095-C
hires and employees in Limited Non-Assessment Periods.
For purposes of reporting on Forms 1094-C and 1095-C,
See Definitions, later, for key terms used in these instructions.
an employee in a Limited Non-Assessment Period is not
TIP
considered a full-time employee during that period.
Sep 07, 2017
Cat. No. 63018M
2017
Department of the Treasury
Internal Revenue Service
Instructions for Forms
1094-C and 1095-C
Purpose of Form
Section references are to the Internal Revenue Code unless
otherwise noted.
Employers with 50 or more full-time employees (including
Future Developments
full-time equivalent employees) in the previous year use Forms
1094-C and 1095-C to report the information required under
For the latest information about developments related to Form
sections 6055 and 6056 about offers of health coverage and
1094-C, Transmittal of Employer-Provided Health Insurance
enrollment in health coverage for their employees. Form 1094-C
Offer and Coverage Information Returns, and Form 1095-C,
must be used to report to the IRS summary information for each
Employer-Provided Health Insurance Offer and Coverage, and
ALE Member and to transmit Forms 1095-C to the IRS. Form
instructions, such as legislation enacted after they were
1095-C is used to report information about each employee to the
published, go to
IRS.gov/form1094c
and IRS.gov/form1095c.
IRS and to the employee. Forms 1094-C and 1095-C are used in
What's New
determining whether an ALE Member owes a payment under the
employer shared responsibility provisions under section 4980H.
Form 1095-C is also used in determining the eligibility of
Section 4980H transition relief. Several forms of transition
employees for the premium tax credit.
relief were available to some employers under section 4980H for
2016. No section 4980H transition relief is available for 2017.
ALE Members that offer employer-sponsored self-insured
Therefore, these instructions have been revised to remove
coverage also use Form 1095-C to report information to the IRS
discussion of section 4980H transition relief, and Form 1094-C
and to employees about individuals who have minimum
has also been revised. Specifically, Form 1094-C, line 22, box C
essential coverage under the employer plan and therefore are
is designated “Reserved”; Part III, column (e) is designated
not liable for the individual shared responsibility payment for the
“Reserved”; and the entry rows in Part III, column (e) are shaded.
months that they are covered under the plan.
Additional Information
Who Must File
For information related to the Affordable Care Act, visit
An ALE Member must file one or more Forms 1094-C (including
www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home. For
a Form 1094-C designated as the Authoritative Transmittal,
the final regulations under section 6056, Information Reporting
whether or not filing multiple Forms 1094-C), and must file a
by Applicable Large Employers on Health Insurance Coverage
Form 1095-C for each employee who was a full-time employee
Offered Under Employer-Sponsored Plans, see T.D. 9661,
of the ALE Member for any month of the calendar year.
2014-13 I.R.B. 855, at www.irs.gov/irb/2014-13_IRB/ar09.html.
Generally, the ALE Member is required to furnish a copy of the
For the final regulations under section 6055, Information
Form 1095-C (or a substitute form) to the employee.
Reporting of Minimum Essential Coverage, see T.D. 9660,
2014-13 I.R.B.842, at www.irs.gov/irb/2014–13_IRB/ar08.html.
An ALE Member is, generally, a single person or entity that is
For the final regulations under section 4980H, Shared
an Applicable Large Employer, or if applicable, each person or
Responsibility for Employers Regarding Health Coverage, see
entity that is a member of an Aggregated ALE Group. An
T.D. 9655, 2014-9 I.R.B. 541, at
www.irs.gov/irb/2014-9_IRB/
Applicable Large Employer, generally, is an employer with 50 or
ar05.html. For answers to frequently asked questions regarding
more full-time employees (including full-time equivalent
the employer shared responsibility provisions and related
employees) in the previous year. For purposes of determining if
information reporting requirements, visit IRS.gov.
an employer or group of employers is an Applicable Large
Employer, all ALE Members under common control (an
For information related to filing Forms 1094-C and 1095-C
Aggregated ALE Group) are aggregated together. If the
electronically visit
www.irs.gov/e-file-providers/air/affordable-
Aggregated ALE Group, taking into account the employees of all
care-act-information-return-air-program. For FAQs specifically
ALE Members in the group, employed on average 50 or more
related to completing Forms 1094-C and 1095-C, go to
full-time employees (including full-time equivalent employees)
www.irs.gov/Affordable-Care-Act/Employers/Questions-and-
on business days during the preceding calendar year, then the
Answers-about-Information-Reporting-by-Employers-on-
Aggregated ALE Group is an Applicable Large Employer and
Form-1094-C-and-Form-1095-C.
each separate employer within the group is an ALE Member.
For additional guidance and proposed regulatory changes
Each ALE Member is required to file Forms 1094-C and 1095-C
relating to section 6055, including clarifications regarding the
reporting offers of coverage to its full-time employees (even if the
reporting requirements for providers of minimum essential
ALE Member has fewer than 50 full-time employees of its own).
coverage and the requirement to solicit the TIN of each covered
For more information on which employers are subject to the
individual for purposes of the reporting of health coverage
employer shared responsibility provisions of section 4980H, see
information, see Proposed Regulations section 1.6055-1(h) and
Employer
in the Definitions section of these instructions. For
Regulations section 301.6724-1.
more information on determining full-time employees, see
General Instructions for
Full-Time Employee
in the Definitions section of these
instructions, which includes information on the treatment of new
Forms 1094-C and 1095-C
hires and employees in Limited Non-Assessment Periods.
For purposes of reporting on Forms 1094-C and 1095-C,
See Definitions, later, for key terms used in these instructions.
an employee in a Limited Non-Assessment Period is not
TIP
considered a full-time employee during that period.
Sep 07, 2017
Cat. No. 63018M
Reporting by Employers That
(Lines 17–22), later. Form 1095-C may be used only if the
individual identified on line 1 has an SSN.
Sponsor Self-Insured Health Plans
Substitute Statements to Recipients
An employer that offers health coverage through a self-insured
health plan must report information about each individual
If you are not using the official IRS form to furnish statements to
enrolled in such coverage. For an employer that is an ALE
recipients, see Pub. 5223, General Rules and Specifications for
Member, this information must be reported on Form 1095-C,
Affordable Care Act Substitute Forms 1095-A, 1094-B, 1095-B,
Part III, for any employee who is enrolled in coverage (and any
1094-C, and 1095-C, which explains the requirements for format
spouse or dependent of that employee). See below for the
and content of substitute statements to recipients. You may
option to file Form 1094-B and Form 1095-B, rather than Form
develop them yourself or buy them from a private printer.
1094-C and Form 1095-C, to report coverage of certain
Substitute statements furnished to recipients may be in portrait
non-employees.
format; however, substitute returns filed with the IRS using paper
must be printed in landscape format.
ALE Members that offer health coverage through an
Authoritative Transmittal for ALE
employer-sponsored self-insured health plan must complete
Form 1095-C, Parts I, II, and III, for any employee who enrolls in
Members Filing Multiple Forms 1094-C
the health coverage, whether or not the employee is a full-time
A Form 1094-C must be filed when an ALE Member files one or
employee for any month of the calendar year.
more Forms 1095-C. An ALE Member may choose to file
multiple Forms 1094-C, each accompanied by Forms 1095-C for
For full-time employees enrolled in an ALE Member’s
a portion of its employees, provided that a Form 1095-C is filed
self-insured coverage, including an employee who was a
for each employee for whom the ALE Member is required to file.
full-time employee for at least one month of the calendar year,
If an ALE Member files more than one Form 1094-C, one (and
the ALE Member must complete Form 1095-C, Part II, according
only one) Form 1094-C filed by the ALE Member must be
to the generally applicable instructions, and should not enter
identified on line 19, Part I as the Authoritative Transmittal, and,
code 1G on line 14 for any month. For an employee enrolled in
on the Authoritative Transmittal, the ALE Member must report
an ALE Member’s self-insured coverage who is not a full-time
certain aggregate data for all full-time employees and all
employee for any month of the calendar year (meaning that for
employees, as applicable, of the ALE Member.
all 12 calendar months the employee was not a full-time
Example 1. Employer A, an ALE Member, files a single
employee), for Form 1095-C, Part II, the ALE Member must
Form 1094-C, attaching Forms 1095-C for each of its 100
enter code 1G on line 14 in the “All 12 Months” column or in the
full-time employees. This Form 1094-C should be identified as
separate monthly boxes for all 12 calendar months, and the ALE
the Authoritative Transmittal on line 19, and the remainder of the
Member need not complete Part II, lines 15 and 16.
form completed as indicated in the instructions for line 19, later.
An employer that offers employer-sponsored self-insured
Example 2. Employer B, an ALE Member, files two Forms
health coverage but is not an ALE Member should not file Forms
1094-C, one for each of its two operating divisions, Division X
1094-C and 1095-C, but should instead file Forms 1094-B and
and Division Y. (Division X and Division Y are units of the same
1095-B to report information for employees who enrolled in the
ALE Member, and thus both report under the same employer
employer-sponsored self-insured health coverage.
identification number (EIN); they are not members of an
Aggregated ALE Group.) Attached to one Form 1094-C are
Note. If an ALE Member is offering health coverage to
Forms 1095-C for the 200 full-time employees of Division X, and
employees other than under a self-insured plan, such as through
attached to the other Form 1094-C are Forms 1095-C for the
an insured health plan or a multiemployer health plan, the issuer
1,000 full-time employees of Division Y. One of these Forms
of the insurance or the sponsor of the plan providing the
1094-C should be identified as the Authoritative Transmittal on
coverage is required to furnish the information about their health
line 19, and should include aggregate employer-level data for all
coverage to any enrolled employees, and the ALE Member
1,200 full-time employees of Employer B as well as the total
should not complete Form 1095-C, Part III, for those employees.
number of employees of Employer B, as applicable, as required
in Parts II, III, and IV of Form 1094-C. The other Form 1094-C
Reporting of Enrollment Information
should not be identified as the Authoritative Transmittal on
line 19, should report on line 18 only the number of Forms
for Non-Employees: Option
1095-C that are attached to that Form 1094-C, and should leave
To Use Forms 1094-B and 1095-B
the remaining sections of the form blank as indicated in the
instructions for line 19, later.
ALE Members that offer employer-sponsored self-insured health
coverage to non-employees who enroll in the coverage may use
Note. Each ALE Member must file its own Forms 1094-C and
Forms 1094-B and 1095-B, rather than Form 1095-C, Part III, to
1095-C under its own separate EIN, even if the ALE Member is
report coverage for those individuals and other family members.
part of an Aggregated ALE Group. No Authoritative Transmittal
For this purpose, a non-employee includes, for example, a
should be filed for an Aggregated ALE Group.
non-employee director, an individual who was a retired
employee during the entire year, or a non-employee COBRA
Example 3. Assume that Employer A from Example 1 is a
beneficiary, including a former employee who terminated
member of the same Aggregated ALE Group as Employer B
employment during a previous year.
from Example 2. Accordingly, Employer A and Employer B are
separate ALE Members filing under separate EINs. Forms
For information on reporting for non-employees enrolled in an
1094-C should be filed in the same manner indicated in
employer-sponsored self-insured health plan using Forms
Examples 1 and 2. Employer A should include only information
1094-B and 1095-B, see the instructions for those forms.
about employees of Employer A in its Authoritative Transmittal,
and Employer B should include only information about
employees of Employer B in its Authoritative Transmittal. No
For ALE Members that choose to use Form 1095-C to report
Authoritative Transmittal should be filed for the Aggregated ALE
coverage information for non-employees enrolled in an
Group reporting combined data for employees of both Employer
employer-sponsored self-insured health plan, see the specific
A and Employer B.
instructions for Form 1095-C, Part III—Covered Individuals
-2-
Instructions for Forms 1094-C and 1095-C (2017)
Similar rules apply for a Governmental Unit that has
should complete lines 15 and 16 per the instructions, and should
delegated its reporting responsibilities for some of its employees
include Employee in the count of total employees and full-time
to another Governmental Unit—see
Designated Governmental
employees reported for those months on Form 1094-C. For the
Entity (DGE)
in the Definitions section of these instructions for
months April through December, on Form 1095-C, Employer A
more information. In the case of a Governmental Unit that has
should enter code 1H (no offer of coverage) on line 14, leave
delegated its reporting responsibilities for some of its
line 15 blank, and enter code 2A (not an employee) on line 16
employees, the Governmental Unit must ensure that among the
(since Employee is treated as an employee of Employer B and
multiple Forms 1094-C filed by or on behalf of the Governmental
not as an employee of Employer A in those months), and should
Unit transmitting Forms 1095-C for the Governmental Unit’s
exclude Employee from the count of total employees and
employees, one of the filed Forms 1094-C is designated as the
full-time employees reported for those months on Form 1094-C.
Authoritative Transmittal and reports aggregate employer-level
When To File
data for the Governmental Unit, as required in Parts II, III, and IV
of Form 1094-C.
You will meet the requirement to file Forms 1094-C and 1095-C
if the forms are properly addressed and mailed on or before the
Example. County is an Aggregated ALE Group made up of
due date. If the due date falls on a weekend or legal holiday,
ALE Members School District, Police District, and County
then the due date is the following business day. A business day
General Office. School District designates the state to report on
is any day that is not a Saturday, Sunday, or legal holiday.
behalf of the teachers and reports for itself for its remaining
full-time employees. In this case, either the School District or the
Generally, you must file Forms 1094-C and 1095-C by
state must file an Authoritative Transmittal reporting aggregate
February 28 if filing on paper (or March 31 if filing electronically)
employer-level data for the School District.
of the year following the calendar year to which the return
One Form 1095-C for Each
relates. For calendar year 2017, Forms 1094-C and 1095-C are
required to be filed by February 28, 2018, or April 2, 2018, if filing
Employee of ALE Member
electronically.
For each full-time employee of an ALE Member, there must be
only one Form 1095-C filed for employment with that ALE
See
Furnishing Forms 1095-C to Employees
for information
Member. For example, if an ALE Member separately reports for
on when Form 1095-C must be furnished.
each of its two divisions, the ALE Member must combine the
offer and coverage information for any employee who worked at
Extensions
both divisions during the calendar year so that a single Form
You can get an automatic 30-day extension of time to file by
1095-C is filed for the calendar year for that employee which
completing Form 8809, Application for Extension of Time To File
reports information for all 12 months of the calendar year from
Information Returns. The form may be submitted on paper, or
that ALE Member.
through the FIRE System either as a fill-in form or an electronic
In contrast, a full-time employee who works for more than one
file. No signature or explanation is required for the extension.
ALE Member that is a member of the same Aggregated ALE
However, you must file Form 8809 on or before the due date of
Group must receive a separate Form 1095-C from each ALE
the returns in order to get the 30-day extension. Under certain
Member. For any calendar month in which a full-time employee
hardship conditions you may apply for an additional 30-day
works for more than one ALE Member of an Aggregated ALE
extension. See the instructions for Form 8809 for more
Group, only one ALE Member is treated as the employer of that
information.
employee for reporting purposes (generally, the ALE Member for
How to apply. As soon as you know that a 30-day extension of
whom the employee worked the greatest number of hours of
time to file is needed, file Form 8809. See the instructions for
service), and only that ALE Member reports for that employee
Form 8809. Mail or fax Form 8809 using the address and phone
for that calendar month. The other ALE Member is not required
number listed in the instructions. You can submit the extension
to report for that employee for that calendar month, unless the
request online through the FIRE System. You are encouraged to
other ALE Member is otherwise required to file Form 1095-C for
submit requests using the online fill-in form. See Pub. 1220, Part
that employee because the individual was a full-time employee
B, for more information on filing online or electronically.
of that ALE Member for a different month of the same calendar
year. In this case, the individual may be treated as not employed
Where To File
by that ALE Member for that calendar month. If under these
Send all information returns filed on paper to the following:
rules, an ALE Member is not required to report for an employee
for any month in the calendar year, the ALE Member is not
required to report for that full-time employee for that calendar
If your principal business,
year. For a description of the rules related to determining which
office or agency, or legal
Use the following address:
ALE Member in an Aggregated ALE Group is treated as the
residence in the case of an
employer for a month in this situation, see the definition of
individual, is located in:
Employee.
Example. Employer A and Employer B are separate ALE
Alabama, Arizona, Arkansas,
Members that belong to the same Aggregated ALE Group. Both
Connecticut, Delaware, Florida,
Employer A and Employer B offer coverage through the AB
Georgia, Kentucky, Louisiana,
health plan, which is an insured plan. In January and February,
Maine, Massachusetts,
Department of the Treasury
Employee has 130 hours of service for Employer A and no hours
Mississippi, New Hampshire,
Internal Revenue Service
of service for Employer B. In March, Employee has 100 hours of
New Jersey, New Mexico, New
Center
service for Employer A and 30 hours of service for Employer B.
In April through December, Employee has 130 hours of service
York, North Carolina, Ohio,
Austin, TX 73301
for Employer B and no hours of service for Employer A.
Pennsylvania, Rhode Island,
Employer A is the employer of Employee for filing purposes for
Texas, Vermont, Virginia,
January, February, and March. Employer A should file Form
West Virginia
1095-C for Employee reporting offers of coverage using the
appropriate code on line 14 for January, February, and March,
-3-
Instructions for Forms 1094-C and 1095-C (2017)
If you are required to file electronically but fail to do so, and
If your principal business,
you do not have an approved waiver, you may be subject to a
office or agency, or legal
Use the following address:
penalty of $260 per return for failure to file electronically unless
residence in the case of an
you establish reasonable cause. However, you can file up to 250
individual, is located in:
returns on paper; those returns will not be subject to a penalty for
failure to file electronically. The penalty applies separately to
original returns and corrected returns.
Alaska, California, Colorado,
Pub. 5165, Guide for Electronically Filing Affordable Care Act
District of Columbia, Hawaii,
(ACA) Information Returns for Software Developers and
Idaho, Illinois, Indiana, Iowa,
Department of the Treasury
Transmitters, specifies the communication procedures,
Kansas, Maryland, Michigan,
Internal Revenue Service
transmission formats, business rules, validation procedures, and
Minnesota, Missouri, Montana,
Center
explains when a return will be accepted, accepted with errors or
Nebraska, Nevada, North
PO Box 219256
rejected for returns filed electronically through the ACA
Dakota, Oklahoma, Oregon,
Kansas City, MO 64121-9256
Information Return (AIR) system. To develop software for use
South Carolina, South Dakota,
with the AIR system, software developers, transmitters, and
Tennessee, Utah, Washington,
issuers, including ALE Members filing their own Forms 1094-C
Wisconsin, Wyoming
and 1095-C, should use the guidelines provided in Pub. 5165
along with the Extensible Markup Language (XML) Schemas
published on IRS.gov.
If your legal residence or principal place of business or
Reminder. The formatting directions in these instructions (for
principal office or agency is outside the United States, file with
example, the directions to enter the 9 digit EIN including the
the Department of the Treasury, Internal Revenue Service
dash on line 2 of Form 1094-C) are for the preparation of paper
Center, Austin, TX 73301.
returns. When filing forms electronically, the formatting set forth
in the XML Schemas and Business Rules published on IRS.gov
Shipping and mailing. If you are filing on paper, send the
must be followed rather than the formatting directions in these
forms to the IRS in a flat mailing (not folded), and do not
instructions. For more information regarding electronic filing, see
paperclip or staple the forms together. If you are sending many
Pubs. 5164 and 5165.
forms, you may send them in conveniently sized packages. On
each package, write your name, number the packages
Substitute Returns Filed with the IRS
consecutively, and place Form 1094-C in package number one.
Postal regulations require forms and packages to be sent by
If you are filing your returns on paper, see Pub. 5223 for
First-Class Mail. Returns filed with the IRS must be printed in
specifications for private printing of substitute information
landscape format.
returns. You may not request special consideration. Only forms
that conform to the official form and the specifications in Pub.
Keeping copies. Generally, keep copies of information returns
5223 are acceptable for filing with the IRS. Substitute returns
you filed with the IRS or have the ability to reconstruct the data
filed with the IRS must be printed in landscape format.
for at least three years, from the due date of the returns.
VOID Box
Electronic Filing
Do not use this box on Form 1095-C.
If you are required to file 250 or more
Corrected Forms 1094-C and 1095-C
information returns, you must file
electronically. The 250-or-more
For information about filing corrections electronically,
requirement applies separately to each type of form filed and
see section 7.1 of Pub. 5165.
separately for original and corrected returns. For example, if you
TIP
must file 500 Forms 1095-B and 100 Forms 1095-C, you must
file Forms 1095-B electronically, but you are not required to file
Forms 1095-C electronically. If you have 150 Forms 1095-C to
Corrected Returns
correct, you may file the corrected returns on paper because
A corrected return should be filed as soon as possible after an
they fall under the 250 threshold. However, if you have 300
error is discovered. File the corrected returns as follows.
Forms 1095-C to correct, they must be filed electronically. The
Form 1094-C. If correcting information on the Authoritative
electronic filing requirement does not apply if you apply for and
Transmittal (identified on Part I, line 19, as the Authoritative
receive a hardship waiver. The IRS encourages you to file
Transmittal, one (and only one) of which must be filed for each
electronically even though you are filing fewer than 250 returns.
ALE Member reporting aggregate employer-level data for all
full-time employees and employees of the ALE Member), file a
Waiver. To receive a waiver from the required filing of
standalone fully completed Form 1094-C including the correct
information returns electronically, submit Form 8508. You are
information and enter an “X” in the CORRECTED checkbox. Do
encouraged to file Form 8508 at least 45 days before the due
not file a return correcting information on a Form 1094-C that is
date of the returns, but no later than the due date of the return.
not the Authoritative Transmittal.
The IRS does not process waiver requests until January 1st of
the calendar year the returns are due. You cannot apply for a
Do not file any other documents (e.g. Form 1095-C)
waiver for more than one tax year at a time. If you need a waiver
with the corrected Authoritative Transmittal.
!
for more than one tax year, you must reapply at the appropriate
CAUTION
time each year. If a waiver for original returns is approved, any
Form 1095-C. If correcting information on a Form 1095-C
corrections for the same types of returns will be covered under
that was previously filed with the IRS, file a fully completed Form
the waiver. However, if you submit original returns electronically
1095-C including the correct information and enter an “X” in the
but you want to submit your corrections on paper, a waiver must
CORRECTED checkbox. File a Form 1094-C (Do not mark the
be approved for the corrections if you must file 250 or more
CORRECTED checkbox on Form 1094-C) with corrected
corrections. If you receive an approved waiver, do not send a
Form(s) 1095-C. Furnish the employee a copy of the corrected
copy of it to the service center where you file your paper returns.
Form 1095-C, unless the ALE Member was and continues to be
Keep the waiver for your records only.
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Instructions for Forms 1094-C and 1095-C (2017)
eligible for and used the alternative method of furnishing under
Original Authoritative Transmittal Form 1094-C
the Qualifying Offer Method for that employee for that year’s
IF any of the following are
THEN ...
furnishing. For more information, see
Alternative Method of
incorrect ....
Furnishing Form 1095-C to Employees under the Qualifying
Offer
Method.
ALE Member or Designated
1. Prepare a new Authoritative
Forms 1095-C filed with incorrect dollar amounts on line 15,
Government Entity (Name and/or
Transmittal, Form 1094-C
Employee Required Contribution, may fall under a safe harbor
EIN)
for certain de minimis errors. The safe harbor generally applies if
2. Enter an “X” in the “CORRECTED”
no single amount in error differs from the correct amount by
box at the top of the form
more than $100. If the safe harbor applies, you will not have to
Total Number of Forms 1095-C filed
correct Form 1095-C to avoid penalties. However, if the recipient
by and/or on behalf of ALE Member
elects for the safe harbor not to apply, you may have to issue a
3. Submit the standalone corrected
Form 1094-C with the correct
corrected Form 1095-C to avoid penalties. For more information,
information present
see Notice 2017-9, 2017-4 I.R.B. 542 , at
IRS.gov/irb/2017-04
Aggregated ALE Group Membership
IRB/ar11.html.
Note. Enter an “X” in the CORRECTED checkbox only when
Certifications of Eligibility
correcting a Form 1095-C previously filed with the IRS. If you are
correcting a Form 1095-C that was previously furnished to a
Minimum Essential Coverage Offer
Indicator
recipient, but not filed with the IRS, write, type, or print
CORRECTED on the new Form 1095-C furnished to the
recipient.
Section 4980H Full-Time Employee
Count for ALE Member
Correcting information affecting statement furnished to
employee using an Alternative Furnishing Method under
Aggregated Group Indicator
the Qualifying Offer Method. If an ALE Member eligible to use
the Qualifying Offer Method had furnished the employee an
Other ALE Members of Aggregated
alternative statement, the ALE Member must furnish the
ALE Group (Name and/or EIN)
employee a corrected statement if it filed a corrected Form
1095-C correcting the ALE Member’s name, EIN, address or
contact name and telephone number. If the ALE Member is no
longer eligible to use an alternative furnishing method for the
Original Form 1095-C Submitted to IRS and Furnished to Employee
employee for whom it filed a corrected Form 1095-C, it must
IF any of the following are
THEN ...
furnish a Form 1095-C to the employee and advise the
incorrect ....
employee that Form 1095-C replaces the statement it had
previously furnished.
Name, SSN, ALE Member EIN
1. Prepare a new Form 1095-C
If you fail to file correct information returns or fail to
furnish a correct recipient statement, you may be subject
!
Offer of Coverage
2. Enter an “X” in the “CORRECTED”
to a penalty. However, you are not required to file
box at the top of the form
CAUTION
corrected returns for missing or incorrect TINs if you meet the
reasonable cause criteria. For additional information, see Pub.
Employee Required Contribution
3. Submit corrected Form 1095-Cs with
1586, Reasonable Cause Regulations and Requirements for
a non-authoritative Form 1094-C
Missing and Incorrect Name/TINs.
transmittal to the IRS
Section 4980H Safe Harbor and
See the charts for examples of errors and step by step
Other Relief Codes
instructions for filing corrected returns.
TIP
4. Furnish a corrected Form 1095-C to
the employee
Covered Individuals Information
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Instructions for Forms 1094-C and 1095-C (2017)

Download Instructions for IRS Form 1094-c, Form 1095-c 2017

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