Form preview

IRS 1094-B 2021 free printable template

Get Form
110116 Form1094BDepartment of the Treasury Internal Revenue Service OMB No. 15452252Transmittal of Health Coverage Information Returns Go2021to www.irs.gov/Form1094B for instructions and the latest
pdfFiller is not affiliated with IRS

Get, Create, Make and Sign IRS 1094-B

Edit
Edit your IRS 1094-B form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your IRS 1094-B form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing IRS 1094-B online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps below to benefit from a competent PDF editor:
1
Sign into your account. If you don't have a profile yet, click Start Free Trial and sign up for one.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit IRS 1094-B. Rearrange and rotate pages, add and edit text, and use additional tools. To save changes and return to your Dashboard, click Done. The Documents tab allows you to merge, divide, lock, or unlock files.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
With pdfFiller, it's always easy to work with documents. Try it out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

IRS 1094-B Form Versions

Version
Form Popularity
Fillable & printabley
4.4 Satisfied (33 Votes)
4.2 Satisfied (32 Votes)
4.8 Satisfied (39 Votes)
4.8 Satisfied (77 Votes)
4.3 Satisfied (83 Votes)
4.2 Satisfied (104 Votes)
4.2 Satisfied (27 Votes)
4.3 Satisfied (152 Votes)
4.4 Satisfied (146 Votes)
4.4 Satisfied (317 Votes)
4.0 Satisfied (28 Votes)
4.0 Satisfied (24 Votes)

How to fill out IRS 1094-B

Illustration

How to fill out IRS 1094-B

01
Obtain the IRS 1094-B form from the IRS website or your tax software.
02
Enter your name and address in the taxpayer information section.
03
Provide your Employer Identification Number (EIN) or Social Security Number (SSN).
04
Fill in part I: Reporting Entity Information, including the name of the entity that provides coverage.
05
Complete part II: Applicable Coverage Information, which summarizes the health coverage offered to employees.
06
If you have more than 250 forms, you need to check the box indicating that you are required to file electronically.
07
Review all entered information for accuracy, including the number of full-time employees.
08
Sign and date the form to certify that the provided information is correct.

Who needs IRS 1094-B?

01
Businesses and organizations that provide minimum essential health coverage to their employees.
02
Employers with 50 or more full-time equivalent employees who need to report health coverage.
03
Self-insured employers that provide health insurance to their employees.

Who needs Form 1094-B?

This form is used by all individuals who file Form 1095-B. Its main purpose is informative.

What is the purpose of Form 1094-B?

The Transmittal of Health Coverage Information Returns is sent to the IRS to inform the total amount of all submitted Forms 1095-B, Health Coverage. The Health Coverage Form serves as proof that a taxpayer was covered by the minimum essential coverage. According to US law every individual must have minimum essential coverage for each month.

What documents must accompany Form 1094-B?

This form should be sent together with Form 1095-B. A separate submission is not needed.

How long does it take to fill the form out?

This is a one-page form, and it takes up to five minutes to complete it.

What information should be provided in Form 1094-B?

The person who fills out the form has to provide the following details:

  • First name
  • Employer Identification Number
  • Name and telephone number of the contact person
  • Address (street, city, state, country and ZIP)
  • Total number of submitted Forms 1095-B
  • The preparer also has to sign the form, indicate their title and date it.
  • The information provided in Form 1094-B must fully correspond to the data in Form 1095-B.

What do I do with the form after its completion?

The completed Form 1094-B is forwarded to the appropriate IRS office.

Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.3
Satisfied
83 Votes

People Also Ask about

Every person that provides minimum essential coverage to an individual during a calendar year must file an information return reporting the coverage. Filers will use Form 1094-B (transmittal) to submit Forms 1095-B (returns).
The main difference between them is that the 1095-C provides information about health insurance and is sent to both employees and the IRS, while the 1094-C acts as a cover sheet about the 1095-C and is sent only to the IRS.
Penalties for Not Filing or Incorrectly Filing Forms 1094/1095-C. As of 2022, the penalty for failing to file an informational return is $280 per return, up to $3.426 million per business. Failure to provide a correct payee statement is also $280 per statement and can be up to $3.426 million per employer.
Employers with 50 or more full-time employees (including full-time equivalent employees) in the previous year use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees.
More In Affordable Care Act See Reporting Offers of COBRA Continuation Coverage and Post-Employment Coverage.) Form 1094-C is used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS. Form 1095-C is used to report information about each employee.
Employers with 50 or more full-time employees (including full-time equivalent employees) in the previous year use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

By integrating pdfFiller with Google Docs, you can streamline your document workflows and produce fillable forms that can be stored directly in Google Drive. Using the connection, you will be able to create, change, and eSign documents, including IRS 1094-B, all without having to leave Google Drive. Add pdfFiller's features to Google Drive and you'll be able to handle your documents more effectively from any device with an internet connection.
Yes. With pdfFiller for Chrome, you can eSign documents and utilize the PDF editor all in one spot. Create a legally enforceable eSignature by sketching, typing, or uploading a handwritten signature image. You may eSign your IRS 1094-B in seconds.
Create your eSignature using pdfFiller and then eSign your IRS 1094-B immediately from your email with pdfFiller's Gmail add-on. To keep your signatures and signed papers, you must create an account.
IRS 1094-B is a transmittal form used to report information about health coverage provided to individuals. It is submitted to the IRS along with Form 1095-B.
Entities that provide health coverage, such as insurance companies, employers, or government programs, are required to file IRS 1094-B if they issue Form 1095-B to covered individuals.
To fill out IRS 1094-B, provide your business information, including name, address, and Employer Identification Number (EIN). Then, indicate the number of returns being submitted and any other required information as guided by the IRS instructions for the form.
The purpose of IRS 1094-B is to summarize and transmit information regarding the health coverage provided to individuals during the year. It is part of the Affordable Care Act (ACA) reporting requirements.
Information that must be reported on IRS 1094-B includes the issuer information (name, address, EIN), the number of Form 1095-B returns filed, and specific details about the covered individuals, including months covered.
Fill out your IRS 1094-B online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Related Forms

If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.