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Item Number: PS1095C500

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2022 Employer Provided Health Insurance Offer and Coverage Forms, pressure seal EZ fold, 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" x14", pressure seal forms, Printed in Black ink. 500 per carton
Brand:TFP Data Systems
Feature 1:Pressure Seal Forms
Feature 2:EZ Fold Pressure Seal Forms
Feature 3: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:14 in
Package Weight:6.10 LB
Package Width:8-1/2 in
Material:Paper
Country of Origin:USA
Manufacturer Part Number:PS1095C500
Number of Forms:500
Number of Items:500
Overall Dimensions:8-1/2 in x 14 in
Perforation:No
Sheet Size:8-1/2 x 14
Ships in:2 to 3 Business Days (plus time in transit)
Size:8-1/2 x 14 in
Style:Laser cut sheet
Text Color:Black