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Employee OMB No. 1545-2251 CORRECTED Applicable Large Employer Member (Employer) 1 Name of employee (first name, middle initial, last name) 2 Social security number (SSN) 3 Street address (including apartment no.) 4 City or town Part II VOID Employer-Provided Health Insurance Offer and Coverage 5 State or province 6 Country and ZIP or foreign postal code Employee Offer of Coverage All 12 Months Jan 7 Name of employer 8 Employer identification number (EIN) 9 Street address (includ.

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Related content

2025 Form 1095-C
May 21, 2025 — This Form 1095-C includes information about the health insurance coverage...
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2022 Form 1095-C
This Form 1095-C includes information about the health insurance coverage offered to you...
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IRS Releases Final Forms and Instructions for 2020...
Oct 19, 2020 — The 1095-C form retains the “plan start month” box, which was...
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