Fillable Transmittal of Health Coverage Information Returns Form 1094-B

Fill Online, Printable, Fillable, Blank Transmittal of Health Coverage Information Returns Form 1094-B Form

Use Fill to complete blank online IRS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Transmittal of Health Coverage Information Returns Form 1094-B

On average this form takes 4 minutes to complete

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

  • 1 signature
  • 0 check-boxes
  • 11 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your IRS forms online.

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.

BROWSE IRS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
110116
Form 1094-B
2018
Transmittal of Health Coverage Information Returns
Department of the Treasury
Internal Revenue Service
▶
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 (2018)
click to sign
signature
click to edit
dd mmm yyyy
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Transmittal of Health Coverage Information Returns Form 1094-B

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 23 May 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document