Blank Pressure Seal 14” EZ Fold 1095

(81650)

Use this blank pressure seal form for printing forms 1095-B and 1095-C.
8 ½” x 14” Sheet


A 1095-B form must be issued by a self-insured employer with less than 50 full-time employees (including full-time equivalent employees), or by the insurer to employees and to the IRS as proof of healthcare coverage. c