This form is a continuation of form 1095-C which allows for only 6 covered individuals to be listed. Use this form when there are 7 or more covered individuals to be listed on form 1095-C.
Pre-printed 1-up laser cut sheet
1 form per sheet (Order by number of forms)
Actual Size: 8.5"W x 11"H
Compatible with envelope 7777
Minimum Order Quantity: 100