Fillable Form 1094-B Transmittal of Health Coverage Information Returns 2019

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Form 1094-B Transmittal of Health Coverage Information Returns 2019

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The Form 1094-B Transmittal of Health Coverage Information Returns 2019 form is 1 page long and contains:

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Country of origin: US
File type: PDF

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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110116
Form 1094-B
2019
Transmittal of Health Coverage Information Returns
Department of the Treasury
Internal Revenue Service
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Go to www.irs.gov/Form1094B for instructions and the latest information.
OMB No. 1545-2252
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 or town
7 State or province 8 Country and ZIP or foreign postal code
9 Total number of Forms 1095-B submitted with this transmittal . . . . . . . . . . . . . .
▶
For Official Use Only
Under penalties of perjury, I declare that I have examined this return and accompanying documents, and to the best of my knowledge and belief, they are true, correct, and complete.
▲
Signature
▲
Title
▲
Date
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 61570P
Form 1094-B (2019)
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Form 1094-B Transmittal of Health Coverage Information Returns 2019

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Completed 26 January 2020

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