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Get IRS 1095-B 2020-2021

Mation. Part II 5 City or town . . . 2 Social security number (SSN) or other TIN 3 Date of birth (if SSN or other TIN is not available) 6 State or province 7 Country and ZIP or foreign postal code 9 Reserved 11 Employer identification number (EIN) Information About Certain Employer-Sponsored Coverage (see instructions) Employer name 12 Street address (including room or suite no.) Part III 13 City or town 14 State or province 15 Country and ZIP or foreign postal cod.

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