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Get IRS 1094-B 2017

For Privacy Act and Paperwork Reduction Act Notice see separate instructions. Signature Title Cat. No. 61570P Date 1094-B 2017. 110116 Form 1094-B Department of the Treasury Internal Revenue Service Transmittal of Health Coverage Information Returns Go OMB No* 1545-2252 to www*irs*gov/Form1094B for instructions and the latest information* 1 Filer s name 2 Employer identification number EIN 3 Name of person to contact 4 Contact telephone number 5 Street address including room or suite no. 6 City .

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