Copyright Supplies Shops. All Rights Reserved

1095-C Employer-Provided Health Insurance Offer and Coverage Form (100 Sheets/Pack)

Item Number: 1095C

Pricing:

Price per
Pack of 100 Sheets
2+
Packs
5+
Packs
10+
Packs
20+
Packs
$60.13 $56.11$52.75$51.13$50.09
Savings6.7%12.3%15%16.7%

Need a larger quantity? Click here for a Pack of 500.

Need a smaller quantity? Click here for a 0.


2022 Employer Provided Health Insurance Offer and Coverage Forms, 100 per pack. This health coverage form shows whether or not the employer offered health coverage to employees. This form is for employers with 50 or more full-time employees. Both insured and self-insured issue 1095-C. 8-1/2" x11", Printed in Black ink. 100 sheets per Pack
Brand:TFP Data Systems
Feature 1:Laser cut sheets for Inkjet and Laser printers
Feature 2:Ships in 4-5 business days
Carbonless:No
Claim Type:1095-C
Color:White
Condition:New
Currency:USD
Holes Punched:No
Pre-Printed:Yes
Package Height:11 in
Package Weight:2.50 LB
Package Width:8-1/2 in
Material:Paper
Country of Origin:USA
Manufacturer Part Number:1095C
Number of Forms:250
Number of Items:250
Perforation:No
Sheet Size:8-1/2 x 11
Ships in:4 to 5 Business Days (Plus time in transit)
Size:8-1/2 x 11 in
Style:Laser cut sheet
Text Color:Black