Internal Revenue Manual
IRM 3.41.267 — Affordable Care Act Information Return Processing on Service Center Recognition/Image Processing System
Part 3. Submission Processing
Chapter 41. OCR Scanning Operations Section 267. Affordable Care Act Information Return Processing on Service Center Recognition/Image Processing System 3.41.267 Affordable Care Act Information Return Processing on Service Center Recognition/Image Processing System Manual Transmittal September 03, 2025 Purpose (1) This transmits revised IRM 3.41.267, Optical Character Recognition Scanning Operations, Affordable Care Act Information Return Processing on Service Center Recognition/Image Processing System. Material Changes (1) Editorial corrections made throughout the IRM as follows: Updated processing valid tax years to 2022 through 2025. Updated delinquent return date ranges for the new processing year to 2026. Updated Naked links. Effect on Other Documents This supersedes IRM 3.41.267 dated December 04, 2024 (effective January 01, 2025). Audience Taxpayer Services, Submission Processing, Data Conversion Operations Effective Date (01-01-2026) James L. Fish Director, Submission Processing Taxpayer Services
Program Scope and Objectives
3.41.267.1 (01-01-2020) Program Scope and Objectives This program provides human intervention for data verification of electronic data record created by optical recognition engines for the purpose of data capture from paper returns filed with the IRS. Purpose: This IRM provides instruction on processing of paper filed Affordable Care Act information returns (ACA IRP) on the Service Center Recognition/Image Processing System (SCRIPS). This instruction converts taxpayer data reported to electronic data records to fulfill the filing requirement. Audience: Submission Processing Data Conversion Operation personnel including: clerks, peripheral operators, leads and supervisors. These instructions apply to all campuses. Policy Owner: The Director of Submission Processing. Program Owner: Mail Management Data Conversion Section, Return Processing Branch (an organization within Submission Processing). Primary Stakeholders: Service and Enforcement, ACA Implementation, Compliance Strategy and Policy and Small Business/Self Employed (SB/SE), Operations Business Support, and Office of Servicewide Penalties. Program Goals: Convert processable paper filed Affordable Care Act information documents to electronic data records.
Background
3.41.267.1.1 (01-01-2018) Background Filers send paper information returns to IRS to fulfill their filing requirement and provide their taxpayer identification number (TIN). The IRS must convert the information present on the paper filings to an electronic data record. Employees input and validate the data present and IRS systems for these records during conversion to electronic data records.
Authority
3.41.267.1.2 (01-01-2022) Authority Authority for these procedures located in Title 26 of the United States Code (USC) or more commonly known as the Internal Revenue Code (IRC). The IRC receives amendments by acts, public laws, treasury determinations, rules, and regulations such as the following: Information Reporting on Health Coverage by Insurers IRC 6055 Information Reporting on Health Coverage by Employers IRC 6056 Failure to File a Correct Information Return IRC 6721 Policy Statements for Submission Processing located in IRM 1.2.1.4, Policy Statements for Submission Processing Activities.
Roles and Responsibilities
3.41.267.1.3 (01-01-2018) Roles and Responsibilities The Director, Submission Processing approves and authorizes issuance of this IRM. The Planning and Analysis staff provides feedback and supports local management to achieve and effectively monitor scheduled goals. The Operations Manager secures, assigns and provides training to perform the instruction. The team manager assigns, monitors and controls the workflow to complete the work timely. The employee applies the instruction to the SCRIPS system to convert paper data to an electronic data record.
Program Management and Review
3.41.267.1.4 (01-01-2020) Program Management and Review Program Reports: Management uses these reports to monitor daily (IPS0698 throughout each workday) and weekly status of the program to completeness. IPS0083, Workstation Operator Statistics Program and Function Summary Report IPS0698, Workflow Status IPS01119, Run Balance Report IPS06440, Throughput Statistics Report PCC 2240, Daily Production Report - Program Sequence PCC 6040, SC WP&C Performance and Cost Report PCC 6240, SC WP&C Program Analysis Report PCB 0440, Daily Workload and Staff Hours Schedule PCB 0540, Weekly Workload and Staffing Schedule Program Effectiveness: Management measures goals using standard documents per hour reports. Each function must complete inventory prior to the program completion date stated in IRM 3.30.123, Work Planning and Control - Processing Timeliness: Cycles, Criteria, and Critical Dates. Local Management ensures quality products conducting and monitoring quality reviews. Managerial or product review in Data Validation function performed each week on every employee and entered in Embedded Quality for Submission Processing System (EQSP). Managerial and product review supplement the quality review process. Annual Review: Review the processes included in this manual annually to ensure accuracy and promote consistent tax administration.
Program Controls
3.41.267.1.5 (01-01-2018) Program Controls Management uses unit production cards (UPCs) to measure and record activity in each function of this program. Management can use local reports to establish information to support daily program control. Local reports never replace the established official reports.
Terms/Acronyms/Definitions
3.41.267.1.6 (01-01-2018) Terms/Acronyms/Definitions Locate terms and acronyms in this instruction in Exhibit 3.41.267-1, Terms/Acronyms/Definitions.
Related Resources
3.41.267.1.7 (01-01-2022) Related Resources The following table lists the IRM primary sources of guidance on the processing of paper filed forms under the Affordable Care Act program. IRM Title Guidance on IRM 3.10.5 Campus Mail and Work Control - Batch/Block Tracking System (BBTS) utilizing BBTS to drop unit production cards for daily incoming receipts and production IRM 3.10.72 Campus Mail and Work Control - Receiving, Extracting, and Sorting receiving, extracting, sorting, and routing mail within the Submission Processing campuses IRM 3.10.8 Campus Mail and Work Control, Information Returns Processing fine sorting, correspondence routing and disposition for Information Returns Program IRM 3.13.62 Campus Document Services - Media Transport and Control shipping of SCRIPS requests IRM 3.41.274 Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System workstation functions, workstation keyboard, windows environment and general instruction for entering data from tax returns and related data through SCRIPS IRM 3.41.275 Optical Character Recognition Scanning Operations, Scanner Operations on Service Center Recognition/Image Processing System scanning returns on the SCRIPS scanner IRM 10.5.1 Privacy and Information Protection - Privacy Policy shipping of SCRIPS requests Document 12990 Records and Information Management Records Control Schedules time frame to destroy paper sample after conversion to electronic data records Document 13056 Shipping Procedures for Personally Identifiable Information (PII) shipping of image SCRIPS requests Document 13144 Proper PII Shipping Procedures shipping of SCRIPS image requests Training 2335-series Instructor's Corner for Submission Processing - SCRIPS course material for SCRIPS entry, located at Instructors Corner for Submission Processing SCRIPS IRMs present on Servicewide Electronic Research Program (SERP) at the following site: Servicewide Electronic Research Program (SERP). Specific instructional links available on the IMF Data Conversion Research Portal located at IMF Data Conversion Research Portal. IRM 3.13.62, Campus Document Services - Media Transport and Control, or IRM 10.5.1, Privacy and Information Protection - Privacy Policy, provides information on shipping Personally Identifiable Information (PII). This hdocument is located at: Postal and Transport Policy.
Introduction
3.41.267.2 (01-01-2018) Introduction This IRM section describes certain tasks necessary in the processing of Affordable Care Act information returns processing (ACA IRP) filed on paper with the Service Center Recognition/Image Processing System (SCRIPS). Submit IRM deviations in writing following instructions from IRM 1.11.2.2, Internal Management Documents System - Internal Revenue Manual (IRM) Process, IRM Standards, and elevated through proper channels for executive approval. The Taxpayer Bill of Rights (TBOR) lists rights that already existed in the tax code, putting them in simple language and grouping them into 10 fundamental rights. Employees are responsible for being familiar with and acting in accord with taxpayer rights. See IRC 7803(a)(3), Execution of Duties in Accord with Taxpayer Rights, and additional information on the Taxpayer Bill of Rights site located at the following location: Taxpayer Bill of Rights.
Source Documents
3.41.267.2.1 (01-01-2025) Source Documents The instructions in this section apply only to the form types listed below for tax years 2022 through 2025: Affordable Care Act Information Returns Processing (ACA IRP) Form, Title Form Characteristics Form 1094-B, Transmittal of Health Coverage Information Returns transmitting one or more Form 1095-B, Health Coverage Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns transmitting one or more Form 1095-C, Employer-Provided Health Insurance Offer and Coverage Stand-alone Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (SA1094C) with an entry in both corrected box (checked) and Part I, Line 19 box (checked) Form 1095-B, Health Coverage transmitted by Form 1094-B, Transmittal of Health Coverage Information Returns Form 1095-C, Employer-Provided Health Insurance Offer and Coverage transmitted by Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
Program Codes
3.41.267.2.2 (01-01-2018) Program Codes Use program code number 44320 for the processing functions of Affordable Care Act information returns instruction in this IRM. Limit output files to approximately 200,000 data records of each form type ("B" and "C" ) to accommodate the receiving systems limitations. Example: A valid output file consists of no more than 200,000 data records of form type "B" and 200,000 data records of form type "C."
How to Use This Internal Revenue Manual (IRM)
3.41.267.2.3 (01-01-2022) How to Use This Internal Revenue Manual (IRM) Keystroke Combinations: Carets enclose keystroke combinations (e.g., <Enter>). A hyphen separates multiple keystroke combinations (e.g., <Ctrl>-M). This means hold down the <Ctrl> key while pressing the M key. Terms and Acronyms - Exhibit 3.41.267-1, Terms/Acronyms/Definitions, lists terms and the definitions of terms related directly and indirectly to ACA IRP SCRIPS processing. QUICK START - Each function (Original Entry Image (OE-Image), Data Validation Image (DV-Image)) begins with QUICK START instructions intended to speed access to a UW. For detailed data entry and validation instructions found in the following narrative, see IRM 3.41.267.9, General Correction Procedures, and the tables and transcription sheet exhibits in the back of this IRM. More general instructions appear in IRM 3.41.274, Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System. Reminder: Whenever IRM 3.41.274, Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System, and this IRM conflict, follow this IRM. Tables Table Location Table Table Entries and Use Exhibit 3.41.267-1 Terms/Acronyms/Definitions provides the corresponding definitions for the provided listing of terms and abbreviations used throughout section 267 of chapter 41 IRM 3.41.267.1.7 Related Resources lists related resources to use in conjunction with the instruction given IRM 3.41.267.2.1 (1) Source Documents Form list and form characteristics lists each form name and title and states the characteristics of each form type IRM 3.41.267.5 (3) Workstation Operations Specific Key Functionality lists specific keyboard keys and key combinations with the functionality of each listed Exhibit 3.41.267-2 States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State lists ZIP Code ranges sorted by the state Exhibit 3.41.267-3 States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code lists states sorted by the ZIP Code range Exhibit 3.41.267-4 Zone Improvement Plan (ZIP) Code, City, and State Exceptions lists exceptions to the ZIP Code ranges Exhibit 3.41.267-5 Alphabetical Listing of Major Cities with Major City Codes and Zone Improvement Plan (ZIP) Codes lists major city codes for use with address entry Exhibit 3.41.267-6 Affordable Care Act Information Return Transcription Sheets lists screen prompt and instruction by form page for use in the OE and DV functions Exhibit 3.41.267-7 Valid Characters list valid characters and describes the characters allowed in fields present on the transcription sheets Transcription sheets: Exhibit 3.41.267-6, Affordable Care Information Return Transcription Sheets is transcription sheets for use in the OE and DV functions. Separate sheets for each form type and page number with screen prompts, description and instruction of each individual data field present on the documents is available. These sheets provide most of the information needed to process ACA IRP documents on SCRIPS.
Affordable Care Act Information Return Processing Document Preparation
3.41.267.3 (01-01-2022) Affordable Care Act Information Return Processing Document Preparation Use IRM 3.41.275, Optical Character Recognition Scanning Operations, Scanner Operations on Service Center Recognition/Image Processing System, for instruction on scanning forms into SCRIPS. Perform perfection on the UW by placing it in the proper succession (order) for scanning. Example: A Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, has a blank page 2 and a completed page 2 followed by a page 3. Cover the entire blank page 2 or copy page 1, to make the work scannable for SCRIPS system. If a condition exists prohibiting scanning of a processable UW, perform OE from paper process on the UW. Note: Form 1094 (series) return must still undergo image only process for the retention copy.
Coding of Late-Filed Submissions
3.41.267.3.1 (01-01-2026) Coding of Late-Filed Submissions Late filed Form 1094-B, Transmittal of Health Coverage Information Returns, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, submissions received from the IRP Sort function with an IRS Received Date stamp require the Delinquent Return Date (IRS received date) and Delinquent Return Indicator information processed. Delinquent Return Indicator - Located in the "For Official Use Only" area (first box). Do not enter a date if indicator is ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡. Delinquent Return Indicator Definition of Indicator Delinquent Return Date ≡ Assessed Return No date entry ≡ ≡ ≡ Collection secured No date entry ≡ ≡ Examination secured No date entry ≡ Suppress notice indicator No date entry ≡ ≡ Prepared by Civil Penalty Unit No date entry ≡ ≡ Penalty assessment is automatic Date entry Return date for tax year 2025≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ for tax year 2024 ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ for tax year 2023≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ for tax year 2022≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ blank Timely filed - no date No date entry A Delinquent Return Date, (boxes 2 through 7) is not present on the transmittal (Form 1094 (series) return) AND delinquent return code ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ is not present, AND it has a valid IRS received date stamp, a delinquent return indicator of "≡ ≡" and a valid received date entered in the 2nd, 3rd, 4th, 5th, 6th and 7th "For Official Use Only" boxes. Enter the date in the MMDDYY format from the boxes or the received date stamp. If there is an "≡" entered in the field and no delinquent return date or an invalid delinquent return date is present remove the "≡ ≡ ≡ ≡" .
Scanner
3.41.267.3.2 (01-01-2022) Scanner See scanner operator instruction in IRM 3.41.275, Optical Character Recognition Scanning Operations, Scanner Operations on Service Center Recognition/Image Processing System, for complete scanner operating instructions. Select manual feed process from the transport console "IRP-ACA" menu to scan hand drop ACA IRP. Note: The system assumes the first page is a Form 1094 (series) return. Scan submissions Form 1094 (series) and all associated Form 1095 (series) again one submission at a time. Note: The scanner does not reject any pages except mechanical rejects. Press the <F3> key to denote the end of the submission and prompts "Start New Batch, or Q to Quit." Do not scan batches or boxes of work having many missing or invalid Form IDs on the submissions but return to IRP Sort function for correction. See IRM 3.41.267.4.1, Unprocessable UW Conditions, for instruction on defining invalid Form ID.
Scanner Rejects
3.41.267.3.2.1 (06-27-2017) Scanner Rejects The scanner prints the reject code "M" (Mixed Document Type) or "X" to the left of the Document Locator Number (DLN) area on any form or page rejection. A mixed document type submission received from the scanning function is one of the form types listed in IRM 3.41.267.2.1 (1), Source Documents. Only non-conforming, mixed, invalid document types, or pages within the submission reject.
Correspondence on Processable Returns
3.41.267.3.3 (01-01-2016) Correspondence on Processable Returns No entry is "valid" for use with this program. Remove any entry present in the screen input if noticed.
Post Document Preparation (Doc Prep) Required
3.41.267.3.4 (01-01-2019) Post Document Preparation (Doc Prep) Required Pull and return to the IRP Sort function daily any documents and Units of Work (UWs) SCRIPS cannot resolve listed on the IRP ACA Pull Document/Submission Report. See IRM 3.41.267.12.9, Pull Unit of Work (Submission) Report for information on the report. Send Integrated Data Retrieval System (IDRS) image requests daily by secure e-mail to the Unit manager of the requesting unit. Use IUUD:IDRS Unit & USR Database located at the following link to retrieve the e-mail addresses: IDRS Unit Samp; USR Database. Use "ESTAB Request" as the subject of the secure e-mail. Note: An IDRS List Report is available under General Reports in the backend of SCRIPS for use on volumes. Local level can complete more actions or negotiate alternate distribution with requesting organizations barring excessive staff hour usage.
Unprocessable Unit-of-Work
3.41.267.4 (01-01-2016) Unprocessable Unit-of-Work Return to the IRP Sort function all unprocessable documents requiring correspondence. The IRP Sort function corresponds with the filer concerning their submission and asks the filer to refile processable documents.
Unprocessable Unit-of-Work Conditions
3.41.267.4.1 (01-01-2021) Unprocessable Unit-of-Work Conditions Consider the following conditions unprocessable: You cannot determine what the taxpayer data is (foreign language, completely illegible). You cannot determine the type of return. You cannot determine the tax year of the return. Invalid tax year on the Form 1094 series. Example: SCRIPS does not process tax years equal to the processing year minus five or more. You cannot determine the tax year of the submission. Example: The tax year on the transmittal and the tax year on all details do not match. When the name of the filer/employer on the transmittal document (Form 1094 (series)) has one or more of the first four characters present illegible, is entirely illegible, or missing and is not available from the first detail record. Exception: For Form 1094-B, Transmittal of Health Coverage Information Returns, the filer is not available from the first detail record or any of the detail documents. The filer altered box titles. The submission is missing a transmittal (corresponding Form 1094 series return). Form ID is invalid, missing, in the wrong font, or in the wrong location on the submission or part of the submission. Units of work (UW) where 50 percent or more of the TINs (social security numbers (SSNs)) show only the last four-digits of the SSNs (appear redacted). Example: If the SSN or a part of the SSN present is masked, hidden, represented by asterisk or, incomplete in any way consider it redacted. When any character in the filer or employer Taxpayer Identification Number/Employer Identification Number (EIN) on the transmittal is illegible or is missing and not available on the first detail. Exception: For Form 1094-B, Transmittal of Health Coverage Information Returns, the filer is not available from the first detail record or any of the detail documents. When the EIN on the transmittal is equal to a repeating number or sequential numbers. Example: A repeating EIN is 11-1111111, 22-2222222, etc., and a sequential EIN is 12-3456789. The submission is a Form 1094-B, Transmittal of Health Coverage Information Returns, with no corresponding Form 1095-B, Health Coverage, records. The employer EIN on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, does not match the employer listed on Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, transmitted and is noticed. Caution: This does not apply to the "B" series. The submission is a Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, with no corresponding Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, records "and" the corrected box "and" line 19 both do not contain a mark.
Unprocessable Unit-of-Work Disposition
3.41.267.4.2 (01-29-2019) Unprocessable Unit-of-Work Disposition Pull unprocessable units-of-work (UW) daily and returned to the IRP Sort unit for taxpayer correspondence or disposition. A report titled, IRP ACA Pull Document/Submission Report, displays unprocessable UWs. Pull these daily and returned to the IRP Sort unit. See characteristics of the report in IRM 3.41.267.12.8, Pull Unit of Work (Submission) Report. Exception: PULL IMAGE ONLY and PULL IMAGE ONLY - NO DLN require resolution in SCRIPS. Tag each condition prior to forwarding to IRP Sort with the reason code given on the pull report for a specific UW to allow the determination of correspondence sent for these unprocessable documents. Example: The site can choose to create a routing sheet and include pull document reason codes, circle the code for each UW and attach it when returning the unprocessable documents to IRP Sort unit.
Workstation Operations
3.41.267.5 (01-01-2022) Workstation Operations Refer to the IRM 3.41.274, Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System, for a description of the items below and other items: Keyboard Layout Login/Logoff Operator Statistics Post-to-Close Interrupt/Resume Suspend/Resume Status Line Window Prompts Key Functions Whenever IRM 3.41.274, Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System, and this IRM conflict, follow this IRM. Each key or key combination description is the functionality while inside SCRIPS and does not apply to keyboard functionality on other programs. Below lists some function key descriptions. Function Key Description <F5> Allows you to move the entry field to a different place relative to the area on the scanned image. <F7> Allows you to go back and review previous documents or previous pages in the unit-of-work. <Insert> Places the cursor in Overstrike Mode. The keyboard is normally in Overstrike Mode; however, <Insert> removes the keyboard from Overstrike Mode. <Ctrl>-<Shift>-<Delete> <Ctrl>-<Shift>-<Del> <Ctrl>-<Delete> Deletes a unit-of-work. <Ctrl>-<Shift> and arrow keys (←→↑↓arrows) Allows you to move the image strip when it is not lined up. Holds the position for the current image. <Ctrl>-D Copies the data from the same field on the previous document. <Page Up> ACA IRP: Allows you to move between page 1, page 2 and or page 3(s) of Form 1094-C, Form 1095-B and Form 1095-C. <Page Down> ACA IRP: Allows you to move between page 1, page 2 and or page 3(s) of Form 1094-C, Form 1095-B and Form 1095-C. <Shift>-<Print Screen> Prints the current screen on the monitor. Caution: Release the Print Screen button first and then the shift key. The printing action begins upon the release of the Print Screen keystroke. <Ctrl>-M Enlarges the size of the scanned image appearing above the entry field. <Ctrl>-L Reduces the size of the scanned image appearing above the entry field.
Forms Identification (FI) Function
3.41.267.6 (01-01-2016) Forms Identification (FI) Function Non-conforming form is when the scanner does not recognize all documents or all pages of the document. These include photocopies of official documents, official forms but for some reason do not meet the official specifications for measurement, homemade documents of varying formats or documents without or with invalid form identification numbers in the upper right-hand corner of the page. The FI function allows the manager/work leader to identify the form (or the page of the form) to avoid rework at the scanner. The FI screen displays an image and an entry template on the right. The entry template permits the operator to select what form type the image is, or to delete a single image or an entire submission from further processing. The menus shown on the screen depend on how your supervisor profiled you. Example: The FI option appears grayed out on the Workstation Main Menu if not in your profile.
Forms Identification (FI) QUICK START
3.41.267.6.1 (01-01-2022) Forms Identification (FI) QUICK START From the Workstation Main Menu, select the numeric code for Original Entry (OE). From the Original Entry (OE) Selection Menu, select the numeric code for Form Identification Selection Menu. From the Form Identification Selection Menu, select the numeric code for the type of FI needed. The first group of images, from a UW requiring identification, opens. If an incorrect option is selected from the Form Identification Selection Menu, press the <Ctrl>-P key combination to set post-to-close and press <F9> to suspend, before entering any data, to return to the Form Identification Selection Menu. Note: Notify your supervisor. Press the <Ctrl>-P post-to-close key combination to end FI after completing the current UW. The system returns to the Form Identification Selection Menu when you complete the last image identification in the UW.
Form Identification (FI) Processing
3.41.267.6.2 (01-01-2025) Form Identification (FI) Processing The system assigns a six-digit sequence number instead of a document locator number (DLN) to documents it cannot identify. This number assists in locating the UW when researching documents. Once the form type/page is identified, the system assigns a DLN to the document. Identify the image by entering the proper number or letter selection from the template in the form identification menu selection. The tables below appear on the SCRIPS workstation directly below each other. Form 1094 Series Menu Option Form/Page/(Form ID) Menu Option Form/Page/(Form ID) A Form 1094-B pg1 (110116) B Form 1094-C pg1 (120118) C Form 1094-C pg2 (120218) D Form 1094-C pg3 (120316) Form 1095 Series Menu Option Form/Page/(Form ID) Menu Option Form/Page/(Form ID) 1 Form 1095-B pg1 (560118) 3 Form 1095-C pg1 (600120) 4 Form 1095-C pg1 (600118) Note: Do not use. 2 Form 1095-B pg3 (560318) 5 Form 1095-C pg3 (600320) 6 Form 1095-C pg3 (600318) Note: Do not use. Press the <Enter> key to complete a selection. Press <F9> to suspend the document for the person working suspense to research when you cannot identify the image. If the image is unprocessable, press "X" to remove the document from further processing. Suspend the document for the supervisor if the image is a form type other than ACA IRP (such as Form 1040 or Form 941) by pressing <F9>. The person working suspense pulls the documents for proper routing before pressing "X" to remove the document from further processing. If multiple form types exist in a submission, research is needed to determine if the submission requires deleting. Deleting the entire submission is sometimes more efficient, than removing many single documents. Delete submissions by pressing the <Ctrl>-<Shift>-<Delete>, <Ctrl>-<Delete>, or <Ctrl>-<Shift>-<Del> key combination. Press the <Ctrl>-P post-to-close key combination to set post-to-close to end the session. The system returns you to the Original Entry (OE) Selection Menu when you complete the last image in the UW.
Original Entry (OE) Function
3.41.267.7 (01-01-2016) Original Entry (OE) Function Use the OE function to manually key enter data from both scanned images and from paper documents. The menus shown on the screen depends on how your supervisor profiled you. Example: This option is grayed on the Workstation Main Menu if it is not in your profile.
Original Entry (OE) Image QUICK START
3.41.267.7.1 (01-01-2022) Original Entry (OE) Image QUICK START From the Workstation Main Menu, select Original Entry (OE). From the Original Entry (OE) Selection Menu, select OE Image Selection Menu. From the OE Image Selection Menu, select IRP ACA OE Image. From the IRP ACA OE Image Selection Menu, select one of the following: 1 - All IRP ACA OE Image 2 - Form 1094-B OE Image 3 - Form 1094-C OE Image After the selection is entered press <Enter> as prompted or press <Alt>-X to exit to previous menu. The first individual document in a UW requiring OE opens. See Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets. The scanned image of the document displays on the left side of the workstation screen. The right side of the workstation screen is where the data is input in the specific field window. If an incorrect option is selected, press the <Ctrl>-P post-to-close key combination and then suspend this UW. Notify your supervisor. If the last data entered is not the last field of the page and there is no other data present on the page, press <F6> key to release a document and display the next template. Press the <Ctrl>-P post-to-close key combination to end OE from Image. The system returns you to the Original Entry (OE) Selection Menu when you complete the last document in the current UW.
Original Entry (OE) Image Processing
3.41.267.7.2 (01-01-2017) Original Entry (OE) Image Processing The Status Line at the bottom of the screen displays the following information: The program field is 44320 for ACA IRP documents. The DLN field is the DLN of the document displayed. The document field is the relative count of the document. Example: If it is the first document in a unit-of-work with 250 documents, the document field shows a count of 1 of 250. The Pg. field is the relative count of the page of the document. Example: If it is Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, page 1, the Pg field shows 1 of 2 or 1 of 3 depending on the length of the return filed; Form 1094-C page 2 shows as 2 of 2 or 2 of 3 depending on the length of the return filed. The Status Line is "IN" when the insert mode is on and "NU" when the numeric mode is on. In OE from Image, you manually enter information into the template using a scanned image of the return as a source.
Original Entry (OE) From Paper Quick Start
3.41.267.7.3 (01-01-2022) Original Entry (OE) From Paper Quick Start From the Workstation Main Menu, select Original Entry (OE). From the Original Entry (OE) Selection Menu, select OE Paper Selection Menu. From the OE Paper Selection Menu, select IRP ACA OE Paper Selection Menu. From the IRP ACA OE Paper Selection Menu, select the form type: 1 - Form 1094-B OE Paper 2 - Form 1094-C OE Paper After the selection is entered press <Enter> as prompted or press <Alt>-X to exit to previous menu. If the wrong program is selected and the first page of the first document is not complete, press the <Esc> key to cancel the entry. You return to the IRP ACA OE Paper Selection Menu.
Original Entry (OE) From Paper Processing
3.41.267.7.4 (01-01-2019) Original Entry (OE) From Paper Processing In OE from Paper, the workstation operators manually enter information into the system and eliminate all transport processing. The operators need the paper IRP ACA units-of-work to perform OE from paper. SCRIPS assigns a DLN for each document entered from paper but does not print them on the documents. As each new IRP ACA document is processed, the system displays the DLN of the document in the DLN field of the Status Line at the bottom right side of the screen. After selecting the form type from the IRP ACA OE Paper Selection Menu, your first prompt is for the form year, followed by the system reminder window "Enter amounts as DOLLARS ONLY." A blank Form 1094-X template is displayed for the first document in the block with the Sequence Number field displayed for entry. The first document must begin with sequence number "00." The Status Line at the bottom of the monitor screen displays the following information: The Program field shows 44320 for IRP ACA documents. The DLN field shows the DLN of the current document. The SUB field shows the relative count of submission work. The Status Line shows "IN" when the insert mode is on and "NU" when the numeric mode is on. Write the DLN assigned by the system in the upper right-hand corner of the paper document (either the Form 1094-X or Form 1095-X as determined at the site location). The system assigned DLN is shown in the DLN field of the Status Line. Reminder: Writing the DLN for the Form 1094-X is necessary so subsequent operators can retrieve the UW. After entering Pg. 1 (or 2), your next prompt is "Is a page 2 (or 3) present?" Never enter a page without significant taxpayer data, not considered processable, or is a page not data captured such as the instruction pages or duplicate taxpayer forms. Exception: Form 1094-B, Transmittal of Health Coverage Information Returns, has a Pg 1 ONLY, therefore the system moves straight into a Form 1095-B, Health Coverage, template. If "Yes," a page 2 (or 3) template is presented. If "No," you see a prompt "Is next document Form 1095-X?" Response Choice If Action Then "Yes" A Form 1095-X is presented asking for a sequence number. Note: When entering a Form 1095-X, the different DLN in the Status Line is like a 1099 detail document in regular IRP versus the 1096 DLN. "No" Presentation is the next sequence number prompt for the same document type. After entering all documents press the <Esc> and <F8> keys to end OE from paper or press <Ctrl>-P (post-to-close) while entering, but before releasing the last document in the UW. The system returns you to the IRP ACA OE Paper Selection Menu.
Releasing a Unit-of-Work in Original Entry (OE)
3.41.267.7.5 (01-01-2018) Releasing a Unit-of-Work in Original Entry (OE) For OE Image, when you release the last document in a UW, this also releases the UW: If <Ctrl>-P is pressed before releasing the UW, the OE Selection Menu opens. If <Ctrl>-P is not pressed, another UW opens.
Selecting a Specific Unit-of-Work in Original Entry (OE)
3.41.267.7.6 (01-01-2022) Selecting a Specific Unit-of-Work in Original Entry (OE) A specific ACA IRP unit-of-work is selected for OE by following these steps: Select the numeric code for Original Entry (OE) from the Workstation Main Menu. The Workstation Main Menu closes, and the Original Entry (OE) Selection Menu opens. The menus shown on the screen depend on how your supervisor profiled you. Enter the numeric code for OE Select Block from the Original Entry (OE) Selection Menu. The Original Entry (OE) Selection Menu closes, and the Open Block/Unit of Work window opens. Enter the 14-digit DLN from the Form 1094 (series) return from the Open Block/Unit of Work window. Press the <Enter> key. The Open Block/Unit of Work window closes and the selected UW opens. If the block is not available, an error message is displayed indicating the block is not available. Example: A message is displayed if you previously worked on the block, or if another operator is currently working on the Block/UW. Enter data using IRM 3.41.267.9, General Correction Procedures, and Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets, and other instruction in this IRM on the open designated Form 1094 (series) document. Press the <Ctrl>-P post-to-close key combination and then suspend the UW if an incorrect UW is selected for the Open Block/Unit of Work menu then notify your supervisor.
Data Validation (DV) Function
3.41.267.8 (01-01-2018) Data Validation (DV) Function The DV function is used to manually correct data from scanned images. The menus shown on the screen depend on how your supervisor profiled you. Example: This option is grayed on the Workstation Main Menu if it is not in your profile. The Status Line at the bottom of the screen displays the following information: The DLN field shows the DLN of the document displayed. The SUB field shows the relative count of the document. Example: If it is the first document in a UW with 80 documents, the SUB field shows a count of 1 of 80. The Pg. field shows the relative count of the page of the document. Example: If it is Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, page 1, the Pg. field shows 1 of 3, page 3 shows as 3 of 3. The Status Line shows "AU" when the automatic mode is on, "IN" when the insert mode is on, and "NU" when the numeric mode is on. Note: AUTO indicator turns the AUTO mode on and off. When AUTO is on, the cursor automatically moves from the current field to the next field requiring perfection. When AUTO is off, the cursor manually moves through every field using the cursor movement keys. A Select Block or Suspended Block in DV requires the operator to restore the AUTO on mode using <Ctrl>--<A>.
Data Validation (DV) From Image QUICK START
3.41.267.8.1 (01-01-2022) Data Validation (DV) From Image QUICK START From the Workstation Main Menu, select the numeric code for Data Validation (DV). From the Data Validation (DV) Selection Menu, select the numeric code for DV Selection Menu. From the DV Selection Menu, select the numeric code for IRP ACA DV Selection Menu. From the IRP ACA DV Selection Menu, select the numeric code needed. The menus shown on the screen depend on how your supervisor profiled you. 1 - All IRP ACA DV 2 - Form 1094-B DV 3 - Form 1094-C DV 4 - All Scanned IRP ACA DV2 The first UW opens, and the cursor stops at the first highlighted field when the AUTO is on. Use the exhibits and the general correction procedures in this IRM to apply corrections. If an incorrect option is selected from the IRP ACA DV Selection Menu before entering any data, press <Ctrl>-P post-to-close, press <F9> to suspend and return to the DV Selection Menu. Notify supervisor. After entering the last field on document, if AUTO is off, press the <F6> key to release the document and display the next template. Press the <Ctrl>-P post-to-close key combination to stop a new block from appearing once the current UW is completed. The system returns you to the Data Validation (DV) Selection Menu when you release the last document.
Selecting a Specific Unit-of-Work in Data Validation (DV)
3.41.267.8.2 (01-01-2022) Selecting a Specific Unit-of-Work in Data Validation (DV) A specific UW of ACA IRP documents, is selected for DV by following these steps: From the Workstation Main Menu, select the numeric code for Data Validation (DV). The Workstation Main Menu closes, and the Data Validation (DV) Selection Menu opens. The menus shown on the screen depend on how your supervisor profiled you. Example: This option does not display on the menu if it is not in your profile. From the Data Validation (DV) Selection Menu, enter the numeric code for DV Select Block. The Data Validation (DV) Selection Menu closes, and the Open Block/Unit of Work window opens. Enter the 14-digit DLN from Form 1094 (series) document. Press the <Enter> key. The Open Block/Unit of Work window closes and the selected UW opens. The first document needing correction opens. Enter data using Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets, and other exhibits, as needed, in this IRM. A suspended UW in DV requires the operator to restore the "AUTO ON" mode. Reminder: If after entering the DLN, the screen goes white for a second and then returns to the menu, the block is technically worked. The system ran through all the system checks resulting in no errors. If an incorrect UW is selected from the Open Block/Unit of Work menu, press the <Ctrl>-P post-to-close key combination and suspend the UW. Notify your supervisor. Use menu option IRP ACA DV2 Select Block to correct blocks exceeding threshold checks previously entered.
General Correction Procedures
3.41.267.9 (01-01-2022) General Correction Procedures Use these procedures as a guide during the Original Entry (OE) and Data Validation (DV) functions. Not all items apply to specific situations in either function. Correction is needed to fields not highlighted if a correction made to a highlighted field creates an error. Sight verify any field with any incorrect characters. If the system stops on a field, sight verify and correct all incorrect items present in the field. If you reach the maximum field length while entering data, the cursor, in most cases, automatically moves to the next field. Remove or correct incorrect characters inadvertently entered in the next field. Any checkbox present on any form type requires sight verification if the system reads the box as marked. The <Ctrl>-4 (Override key) is not enabled for field character type, tax year, or invalid date of birth (MMDDYYYY). Example: Invalid dates: 01321980, 13011980, 00011980, 01020080 or a date before 01011902. Date of Birth (DOB) fields require entry in MM, DD, YYYY format. When the taxpayer entry YY is present and the century (taxpayer intent) is determined entry the YYYY. An entry missing any of the combination "is not" a DOB. Do not enter any data in the field if you cannot determine all three things. Error Messages—Messages found in the Prompt Area with information giving helpful hints to correct the error. Most error messages consist of two lines with the first line displaying the error message and the second information to help resolve the error condition. An asterisk (*) at the upper right-hand corner of the normal proper placement of the numerous check boxes present on the return represent the skip key stop points. Caution: Taxpayer generated forms may not have the checkbox placement in the correct location. Do not mistake the skip box asterisk for taxpayer entries during OE or DV operations. While working in OE Image or DV Image, if you cannot determine the data for any field (except the Street Address, City fields) from the image because it is illegible or the image is incomplete, suspend the UW and pull the paper document for verification. While working in OE Image or DV Image, do not enter data marked out or crossed through by the filer. Do enter data written in or placed on the document in different font. Press the <F11> key to view the entity information from a Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, while the transmitted form is displayed for reference. It also displays the entity information from the transmitted form while a Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, is displayed. In certain situations, the scanner may read a name or address or even a city without spaces or spread over the name line or address fields. If the system read the name and address correctly, leave as is. Note: If the scanner reads a line correctly but placed the information in an incorrect field, move the information as scanned to the correct entry field using <Shift> up and down arrows. Moving an address to the correct field does not require updates to standard abbreviations. The <Ctrl>-<F7> combination key function provides the operator the ability to access the last edited field or the last flagged field of the previous document. Taxpayer identification number, social security number or employer identification number fields, presented as 1-xxx-xx-xxxx-0 or 1-xx-xxxxxxx-0, or any variation thereof, is entered as xxxxxxxxx, omitting the leading and ending numeric. If detail documents (Form 1095 series) presented consecutively have the same responsible individual or employee and the same covered individuals duplicated, enter one document and void the duplicate(s). For more information on function keys refer to the table in IRM 3.41.267.5 (3), Workstation Operations, or IRM 3.41.274, Optical Character Recognition Scanning Operations, General Instructions for Processing via Service Center Recognition/Image Processing System, Exhibit 3.41.274-1, Function Key Use and Description by Form Type. Cross field validations occur on certain conditions and require sight validation and verification. Follow the screen prompts to allow systemic determination of the disposition of the UW. See the table below for these conditions. Form Number Field Comparison Field(s) Valid Condition Invalid Condition(s) Requiring Sight Verification Form 1094-C Line 19 Part II Part III Part IV L19 is blank PII, PIII and PIV is blank. L19 is marked PII, PIII and PIV each has some or all data. L19 is blank PII, PIII and PIV each or individually partially or fully populated. L19 is marked PII, PIII and PIV is blank. >sight verify Form 1095-B and Form 1095-C Covered Individuals SSN DOB SSN is present and no DOB is present SSN is not present and a valid DOB is present No SSN is present no DOB is present and no name is present Partial SSN is present and no DOB is present SSN is not present and an invalid DOB is present No SSN is present no DOB is present and no name is present >sight verify Form 1095-B and Form 1095-C All 12 months one or more 'month' marked All 12 months box is checked, and Jan through Dec boxes have no checks All 12 months box is checked and one or more of Jan through Dec boxes have a check >sight verify Form 1095-B Page 3 SSN and/or DOB Page 1 Line 2 and/or Line 3 Entries match data capture continues Entry mismatch Page 3 is dropped >sight verify Form 1095-C Tax Year 2019 Page 3 Employee SSN Page 1 Line 2 Entries match data capture continues Entry mismatch Page 3 is dropped >sight verify The system performs threshold validations and places documents in DV2 when 50 percent or more of the SSNs and/or DOBs in the UW appear missing or invalid. This condition requires sight validation and verification. Turn the AUTO off and arrow back to column A under covered individuals to correct erroneously entered name field data. Follow the screen prompts to allow systemic determination of the disposition of the UW. See threshold reason codes at IRM 3.41.267.12.9 (4). Note: A pop-up notification appears at the beginning of the block, "This submission does not meet threshold validation criteria: Invalid SSN and DOB. It deletes after DV unless the field data is modified." Press "OK" and proceed with sight verification.
Name and Address Block Reader (NABR)
3.41.267.9.1 (01-01-2019) Name and Address Block Reader (NABR) Name and Address Block Reader is referred to as NABR. NABR is used to improve the accuracy of addresses captured by the scanner from IRP documents. The NABR accomplishes this improvement by comparing the address captured by the scanner with a database of addresses used by the United States Postal Service. SCRIPS uses NABR to run addresses through a Postal Database. When validating a NABR change, ensure the system read the correct ZIP Code. Correct the data to match the image if the city and state do not match the image and a correct ZIP Code is not present in the data field. The system prompts an operator to "Please verify" the following conditions: State is determined by the system from the city present State is determined from the ZIP Code present City is updated by the system to a phonetic match City is determined from ZIP Code Acceptable city name used Note: NABR does not appear in the bottom right-hand corner in the conditions listed above.
Name Entry
3.41.267.9.2 (01-01-2022) Name Entry Enter the information as shown on the document, in the provided name line or the first, middle initial, and last name/full name except as instructed below: If the filer has submitted the same name twice on a form, enter it only once. Space for a period. Never enter two consecutive spaces. If during sight verification a correction is made, or if in OE, enter the first name first and last name last. Space within a true last name where shown. Omit apostrophe (') if shown in name line. Do not space for an apostrophe. Omit slash (/) if shown in name line. Space for a slash. Enter a hyphen (-) where shown. Do not space before or after the hyphen. Enter numerics present in the name line. Enter ampersand "&" when present in the Form 1094 series name line or the Form 1095 series last name/full name line. Data normally entered on Name line 2, such as; doing business as (DBA), in care of (C/O) or %, or also known as (AKA) is entered/placed behind the business name if a correction requires your intervention. Note: Do not enter %, DBA or AKA. If scanner reads DBA or TA (Trust Agreement) correctly and no other correction is needed, leave as is. Omit the designation only such as Trust Agreement (TA), DBA, AKA, Owner, Proprietor when entering data. Note: Do not enter DBA or TA. If scanner reads DBA or TA correctly and no other correction is needed, leave as is. Do not enter the designations or data for: Formerly known as (FKA), formerly DBA or any data after these designations. Separate the name entered on the form to the first name, middle initial, and last name fields if able to determine the data when the filer does not place the names in the proper fields. Official forms have specific areas for first name, middle initial, and last name. If you cannot determine place the entire name present in the last name field. Do not enter "No Middle Initial" (NMI), "No Middle Name" (NMN), or "No Last Name." Always enter suffixes Jr., Sr., or Minor after the last name in the last name field. Omit suffixes such as MD, TP, and SP. If only a single name appears consider it the last name and enter it in the last name field.
Address Elements
3.41.267.9.3 (01-01-2018) Address Elements Enter the information exactly as shown on the document except as instructed below or when the NABR has perfected the address. See IRM 3.41.267.9.1, Name and Address Block Reader (NABR): Do not enter periods in the address field. However, acceptable punctuation such as slash (/) and hyphen (-) may be entered. If a period is present between two numbers enter a space for the period. If an ampersand (&) is present in the street address enter as AND. If an apostrophe (') is present omit the apostrophe and do not leave a space for the apostrophe. If perfecting only part of the address, such as the state or ZIP Code do not go back to the street address to abbreviate or correct characters if the scanner picked up the street address as present on the document. Exception: If the name of the street is a direction, the direction is spelled out. Do not abbreviate street names. Example: 123 North Street is entered as 123 NORTH ST. If a document has a street address and a PO Box, enter both on the address line with the PO Box or (*) entered first. If the combination is too long, enter only the PO Box. Also, use abbreviations as necessary to limit this entry to 35 positions. Enter as much of the street address with abbreviations as possible. When two street addresses with the same city and ZIP appear, enter the first street address. If two addresses appear, including a PO Box and an address, with different city and ZIP Code, enter the first in the address, city, state and ZIP Code fields. Omit "No, No., Num, #, or Number" if it appears as a prefix to a house, apartment, Route, or PO Box number. If North, South, East or West is shown as part of the city name, use the standard abbreviation (such as N=North, S=South, etc.). NEVER use a Major City Code and the standard abbreviation together. Example: West Miami enter as W MIAMI, not W MF. If the city has numerics, enter as alphas. Example: 29 Palms enter as TWENTY NINE PALMS. Abbreviate only the last designation present if multiple street designations appear. Example: 1234 Circle Road Drive is entered as: 1234 CIRCLE ROAD DR If correcting or transcribing an address field add ST, ND, RD or TH to a numbered street when there is a street designation such as Road or Street. Note: 102 S. 38 Road is entered as 102 S 38TH RD If the street address is not determined or is blank, enter "Z" in the Address field. If the city is not determined or is blank, enter "ZZZ" in the City field and leave the State and ZIP Code fields blank. Enter standard abbreviations for states and territories as shown in Exhibit 3.41.267-2, States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State, and Exhibit 3.41.267-3, States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code. If there is no state, but a ZIP Code is present, enter the ZIP Code as shown and press <Enter>. This generates the state code for this ZIP Code in the prompt area. Follow the screen prompt to accept this code or to enter a different code. If there is no ZIP Code (or the ZIP Code is less than or more than five digits) but a state is present, press the <Enter> key in the ZIP Code field. The system generates the default ZIP Code for this state. Note: DO NOT generate the default ZIP Code without first entering the ZIP Code "if" present on the form. If the system finds the ZIP Code entered and present on the form does not match the state code present, the system asks, "Is this a foreign address?" If the answer is "Yes" the system continues by presenting fields for a foreign address entry, Province (17 characters), Foreign postal code (35 characters). If the answer is "No" the system corrects the ZIP Code upon pressing <Enter>. Note: DO NOT generate the default ZIP Code without first entering the ZIP Code present on the form. Enter foreign street addresses in the street Address field, foreign city in the City field, foreign province in the State/Province field, and country and foreign postal code in the ZIP/Foreign Postal Code field. Use abbreviations as necessary to limit this entry to 35 positions. Enter Army Post Office (APO), Diplomatic Post Office (DPO) and Fleet Post Office (FPO) addresses with the proper two-character state code followed by the corresponding unique five-digit ZIP Code. When an APO, DPO or FPO is used, do not enter any other data in the City field. If the ZIP Code is out of range on APO, DPO or FPO addresses, enter 34001 for Miami, 09001 for New York and 96201 for San Francisco or Seattle. When APO, DPO or FPO is put in the City field, the state code field must correspond with the tables below. Valid Zone Improvement Plan (ZIP) Code for APO, DPO and FPO State Code ZIP Code Range Geographic Location AA 340 Americas AE 090-098 Europe AP 962-966 Pacific Example: EXAMPLE: ENTER AS: APO New York, NY 091XX APO AE 091XX FPO San Francisco, CA 962XX FPO AP 962XX
Transmittal Taxpayer Identification Number (TIN)
3.41.267.9.4 (02-19-2016) Transmittal Taxpayer Identification Number (TIN) Each transmittal Form 1094 (series) return must have a complete nine-digit (numeric) employer identification number (EIN) present as a processable UW. If the EIN is a single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 then the submission is considered unprocessable. If no EIN is present and an SSN format is present suspend the UW. The format for EIN is NN-NNNNNNN and the format for SSN is NNN-NN-NNNN. If the TIN/EIN is missing, illegible, or has more than or less than nine-digits on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and it is found on the first detail document or determined enter the EIN from the first detail document (Line 8) in the field. Reminder: You cannot secure the filers EIN for Form 1094-B, Transmittal of Health Coverage Information Returns, from the details Form 1095-B, Health Coverage. If the complete EIN for a transmittal is not found on the return submission delete the UW by placing nine zeros (000000000) in the EIN field.
Money Amount Fields
3.41.267.9.5 (04-23-2018) Money Amount Fields Money fields consist of dollars only. Enter money amounts as follows: If a dollar amount is present and no cents, enter dollar amount. If a dollars and cents amount is present, enter the dollars only. Note: Do not round the dollars up or down based on cents if present. If a dollar amount is present and it is followed by a line, dash or hyphen, enter the dollar amount. If a dollar amount is present and the cents is lined through, enter dollar amount. If a dollar amount of 0 or 00 is present enter a single 0. If money amount is a negative zero (e.g., -00, -0.00. -00.00, etc.), remove it. Press <F3> to clear the field, and then press the space bar then <Enter>. Do not enter negative amounts (identified with a minus (-) before the amount or the amount is within brackets). If two or more money amounts appear on the same line, press <F3> to clear the field and then enter the first dollar amount present. If the money amount is illegible, suspend the UW as "Poor Quality Image" (<F9>; press "S" ; select "Poor Quality Image" ). If after suspending for "Poor Quality Image" you still cannot determine the correct money amount from the physical document, press <F3> to clear the field and then press the space bar then <Enter>. If a code or other non-monetary entry is present in a monetary field press <F3> to clear the field, then press the space bar followed by <Enter>.
Deleting a Unit-of-Work or Submission
3.41.267.9.6 (01-01-2017) Deleting a Unit-of-Work or Submission To delete a filer's entire submission (or UW, or transmittal), enter nine zeros in the EIN (Line 2) or "00" in the tax year of the Form 1094 (series) return. Pull and send the deleted Form 1094 (series) and all the associated detail documents back to the IRP Sort function. Deleting a submission is usually a procedure used by a manager or work leader. Always delete a submission if: The detail document Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, line 7 and 8, Applicable Large Employer Member (Employer), does not match the employer present on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. The filer changed box titles. The tax year is not clear. The tax year of the transmittal and all the detail documents do not match. The tax year is invalid including future tax years. The incorrect detail document type is selected during "FI." The Form 1094 (series) return is missing either the name (Line 1) or EIN (Line 2) of the filer or employer. Exception: On Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, if Line 1-2 is blank and Line 9-10 is not blank, SCRIPS moves the Line 9-10 entity data to Line 1-2 entity data systemically after operator verification of the data fields. The Form 1094 (series) return first four characters of the filer or employer name is illegible and is not retrievable within the submission.
Voiding a Supporting Detail Document
3.41.267.9.7 (01-01-2022) Voiding a Supporting Detail Document A supporting detail document is a Form 1095 (series) only. Void an individual detail Form 1095 (series) document if: The void box on the top of the form is marked. The form is crossed out or the word VOID is written over or across it. Note: The void box marked by the filer or employer makes all data on the form invalid. The void box and corrected box both appear checked. The only data on the document (detail) present is the Part I entity data AND the detail is not marked corrected (the CORRECTED box is not marked). The form is a summary record in the submission. Example: The form is marked by the filer as a "summary, total, or subtotal" form. The form is blank. Detail documents (Form 1095 series) presented consecutively with the same responsible individual or employee and the same covered individuals duplicated, enter one document and VOID the duplicate(s). The printed physical form is missing data due to improper printing of the form by the taxpayer. One or two Form 1095-C documents have a different employer than the rest of the documents. You can determine several Form 1095-C documents do not belong in the submission. DO NOT void a document (detail) if the system misread and placed an "X" in either the void or corrected boxes when one is not present on the document.
Re-Imaging Form 1094 Series Returns
3.41.267.10 (01-01-2018) Re-Imaging Form 1094 Series Returns The <F12> key allows you to flag or mark a Form 1094 (series) return to go to Image Only processing. Perform Re-image (Image only) processing when the true and complete image is not clear or complete. Re-image the return if any page of the return has processable taxpayer entries and the following exist: Skewed, folded or otherwise unreadable Scanned in backwards
Form 1094 Series Image Only Processing
3.41.267.11 (01-01-2018) Form 1094 Series Image Only Processing SCRIPS scanning function for image only processing and archiving is done for submissions processed for re-imaging (the <F12> key is used) or processed using OE paper. Only a true and complete image is taken for this purpose. To allow for retrieval of the image in the future, the DLN is key entered with each image. The menus shown on the screen depend on how your supervisor profiled you. Example: This option is not present on the Data Validation Function Menu if it is not in your profile.
Form 1094 Image Only
3.41.267.11.1 (01-01-2022) Form 1094 Image Only From the Workstation Main Menu, select Data Validation (DV). From the Data Validation (DV) Selection Menu, select IRP ACA Form 1094 Image Only. A Form 1094 Image Only block opens with up to 100 records/returns. Note: 100 records or returns equal more than 100 images due to multiple page records/returns. If an image is not recognized by the scanner, a window opens allowing you to identify the image and page of each image of Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. You can remove a single image or entire block from further processing. The window offers the options below: DV Image Only Selection Screen Selection Form/Page/ (Form ID) A Form 1094-B pg. 1 (110116) B Form 1094-C pg. 1 (120118) C Form 1094-C pg. 2 (120218) D Form 1094-C pg. 3 (120316) X Remove If the image is not either form type/page number, then press <F12> to remove the document from further processing. Press <Ctrl>-<Shift>-<Delete> or <Ctrl>-<Shift>-<Del> key combination to remove the entire block. If the image is identified as a Form 1094 series form type page 1 then the DLN is entered. If the document is removed or not a page 1, a DLN is not assigned or entered. If the record/return is the same block number, only the two-digit sequence number is entered. If the block number changes, then enter the 14-digit DLN. Whenever a 14-digit DLN is entered, the DLN is validated by requiring you to enter it twice. Each component of the DLN (i.e., the File Location Code, Tax Class, Document (Doc) Code, Julian Date, Blocking Series, Sequence Number and Year Digit) undergoes validation. Any invalid component generates an error message explaining the error.
Supervisor Section Affordable Care Act Return Program Reports
3.41.267.12 (01-01-2020) Supervisor Section Affordable Care Act Return Program Reports The following is a listing of the Affordable Care Act information return reports available on SCRIPS: IRM 3.41.267.12.1, Document Locator Number (DLN) Output Report IRM 3.41.267.12.2, Assigned Document Locator Number (DLN) Report IRM 3.41.267.12.3, Cumulative Document Locator Number (DLN) Assignment Report IRM 3.41.267.12.4, Workflow Status Report IRM 3.41.267.12.5, Override Report IRM 3.41.267.12.6, Inventory Report IRM 3.41.267.12.7, Production Report IRM 3.41.267.12.8, Run Balancing Report IRM 3.41.267.12.9, Pull Unit of Work (Submission) Report IRM 3.41.267.12.10, Throughput Statistics Report IRM 3.41.267.12.11, Workstation Operator Statistics - Program and Function Summary Report The following subsections have the content found on the report.
Document Locator Number (DLN) Output Report
3.41.267.12.1 (01-01-2016) Document Locator Number (DLN) Output Report The title of the report is IRP ACA DLN Output Report (IPS01118). The report reflects the entire production for the site for a given time frame. The report has the following: Service Center Run Date Page number Program number DLNs and a notation if it is a transmittal DLN or detail DLN File Location Code (FLC), Tax Class and Document Code (TAX/DOC), Julian date, Block number and Volume
Assigned Document Locator Number Report
3.41.267.12.2 (01-01-2016) Assigned Document Locator Number Report The title of the report is IRP ACA Assigned DLN Report (IPS03339). The report reflects production for the individual scanner for a given time frame. The report has the following: Program number Run Date and Time Scanner Job ID Start Time End Time DLNs and a notation if it is a transmittal DLN or detail DLN File Location Code (FLC), Tax Class and Document Code (TAX/DOC), Julian date, Block number and Volume The summary page for the scan job by document code and form type
Cumulative Document Locator Number (DLN) Assignment Report
3.41.267.12.3 (05-03-2017) Cumulative Document Locator Number (DLN) Assignment Report The title of the report is IRP ACA Cumulative DLN Assignment Report (IPS11110). The report reflects the total number of DLN assignments by form type and form page time frame. The report has the following: Doc Code - Document Code Four-digits, digit one and two is the document code Digits three and four represent the page number Form Form number followed by page number (P1, P2, P3, etc.) Volume Total End Time
Workflow Status
3.41.267.12.4 (01-01-2020) Workflow Status The title of the report is Workflow Status (IPS0698). This report lists the task/sub-task number, the sub-task description, blocks at the sub-task, total documents for the block, and documents ready for the sub-task. This report also has percentages for system capacity used under the following three categories: General, IRP, and IRP/ACA/K1/941/940/Stand-Alone. This report is used to monitor documents and system capacity throughout each workday.
Override Report
3.41.267.12.5 (01-01-2018) Override Report The title of the report is IRP ACA Override Report (IPS11100). The report reflects the total count of override keystrokes for a given time frame. The report has the following: Function Code Doc Code - Document Code two-digit number Field Number Field Description Override Count End Time
Inventory Report
3.41.267.12.6 (01-01-2016) Inventory Report The title of the report is Inventory Report (IPS03350). The report reflects inventory for a given time frame reflecting the carry over form volume on SCRIPS. The report has the following: Initial Inventory Process Date Returns Input Returns Deleted Returns Output Carry Over Inventory End Time
Production Report
3.41.267.12.7 (02-19-2020) Production Report The title of the report is IRP ACA Production Report (IPS11120). The report reflects the following scanned volumes and year to date output totals. The report has the following: Service Center Run Date and Clock Time Page number Scanned volumes by document code and form type for today, subtotals and totals Output volumes by document code and form type and deletes for year to date along with cumulative, subtotals and totals Status summary for all functions for today/current and year to date cumulative This report records ACA IRP production though the processing year and, as possible, daily activity and aids in validating production volume. Use this report for analyzing production reports for accuracy. Site staff generates the IRP ACA Production Report late Friday or early Monday weekly and e-mails it by close of business Monday (or first workday of the work week) to National Office at *IT SCRIPS PO every week.
Run Balancing Report
3.41.267.12.8 (02-19-2016) Run Balancing Report The title of the report is IRP ACA Run Balancing Report (IPS01119). The report reflects the entire production for the site for a given date. The report has the following: Service Center Run Date Page number FTP File ID number The file name (i.e., OCR1010B for forms in the B series and OCR1010C for forms in the C series)
Pull Unit of Work (Submission) Report
3.41.267.12.9 (01-01-2026) Pull Unit of Work (Submission) Report The title of the report is IRP ACA Pull Document/Submission Report (IPS00812). The report lists submissions and documents to pull (or counted as deleted) for a date range. The report has the following: Service Center Run Date and clock time Page# - Number Block# Doc DLN/Seq# - Document DLN Sequence number App - Application FI, OE or DV SEID - Standard Employee Identification Note: An SEID of 000000 represents the SCRIPS system and creates the action based on programming and or specific responses to questions posed to the clerk. Date/Time Reason The reason is one of the following pull document report codes: Reminder: See IRM 3.41.267.4.2, Unprocessable Unit-of-Work Disposition, to determine the disposition of the UWs and documents pulled. Most of the pull report work requires forwarding to IRP Sort for correspondence as unprocessable documents. Tag each condition prior to forwarding to IRP Sort. Report Reason Condition SINGLE ORIGINAL Form 1094-C Stand-alone Original Form 1094-C CONSECUTIVE PARENT Two consecutive Form 1094-X MISSING PARENT NAME Name missing from Form 1094-B (Line 1) or Form 1094-C (Line 1 and Line 9) transmittal return MISSING PARENT EIN Missing valid nine-digit EIN on Form 1094 series return MIXED SUBMISSION Mixed form types Example: Marked "Remove" in FI. INVALID TAX YEAR Invalid Tax Year PULL IMAGE ONLY Marked "Remove" in Image Only Note: Requires rescanning. PULL <F12> is pressed to remove document in OE/DV PULL STANDALONE Form 1094-B Stand-alone Form 1094-B PULL IMAGE ONLY - NO DLN <F12> is pressed in Image Only on recognized document Note: Requires rescanning. DEL UW - INVALID SSN/INVALID DOB Threshold: Form 1095-B – Line 2/Line 3 DEL UW - INVALID DOB Threshold: Form 1095-B – Line 3 DEL UW - INVALID ORIGIN OF POLICY Threshold: Form 1095-B – Line 8 DEL UW - INVALID EINS Threshold: Form 1095-B – Line 11 DEL UW - INVALID SSN/INVALID DOB Threshold: Form 1095-B – Line 23(b)-40(b) SSN/DOB DEL UW - INVALID DOB Threshold: Form 1095-B – Line 23(c)-40(c) DOB DEL UW - INVALID MONTH COMBO Threshold: Form 1095-B – Line 23(d)-40(d) Months Covered DEL UW - INVALID NAME Threshold: Form 1094-C – Line 1 DEL UW - INVALID MISSING NAME/SSN Threshold: Form 1095-C – Line 1/Line 2 DEL UW - INVALID SSNS Threshold: Form 1095-C – Line 2 INVALID PLAN MONTH Threshold: Form 1095-C – Plan Month DEL UW - INVALID SSN/INVALID DOB Threshold: Form 1095-C Tax Year ≥ 2022 = Line 18-30(b)-Line 18-30(c) DEL UW - INVALID DOB Threshold: Form 1095-C Tax Year ≥ 2022 = Line 18-30(c) Physically pull only documents on the Pull Document Report for correspondence, Re-imaging or routing to some other function for action. Do not physically pull the following: Blank pages Instruction pages Duplicate pages deleted by clerks Extraneous pages sent by the filer when the UW is sent to output successfully
Throughput Statistics Report
3.41.267.12.10 (05-03-2017) Throughput Statistics Report The title of the report is Throughput Statistics Report (IPS06440). The report reflects processing function productions for a given date range. The report rows reflect the following process functions: Scandriver, Transport/Sync, OE Crossover, Form Identification, Block Verification, OE Image, OE Paper, Program Validation, Data Validation, QR Summarization, Block Output, Image Archive, Backup Image Archive and Block Purge. The report has the following: Service Center From and to date range and clock time Run Date and clock time Page Number Processing Function Total Blocks Total Documents Process Time Documents Per Hour
Workstation Operator Statistics Program and Function Summary Report
3.41.267.12.11 (05-03-2017) Workstation Operator Statistics Program and Function Summary Report The title of the report is Workstation Operator Statistics Program and Function Summary Report (IPS00803). The report displays the number of documents processed in each function for a given date range. Process function listed on the report rows: 460, 470, 480, 47X, and 48X. The report has the following: Service Center From and to date range Run Date and clock time Page Number Function Code Program Number Number of Documents Process Time Total Keystrokes Keystrokes Per Hour Documents Per Hour Summary by Programs
Block Status Window
3.41.267.13 (01-01-2018) Block Status Window The Block Status window shows a more detailed status of the blocks/UWs in the search criteria data entered in the Block Search Criteria window. A change of operational parameters of blocks/UWs is completed in the Block Status window. Depending on the parameter, a change to the parameter for individual blocks/UWs or multiple blocks/UWs is completed at the same time. Press the <Alt>-A key combination for selection of all blocks eligible for selection. This excludes blocks in a status of "DELETE" or "DONE." The result is a check symbol mark on selected blocks in the Block Selected for Update column. Press the <Alt>-A key combination again to deselect all blocks if you choose to not perform updates on the selected blocks. Press the <Alt>-X key combination if you choose to cancel the blocks selected and close the Block Status window. Block status monitoring (IPS0697) window shows a more detailed status of the blocks/UWs.
Output Verification Audit
3.41.267.13.1 (01-29-2019) Output Verification Audit An output verification process ran on all UWs prior to output systemically suspends any UW with invalid conditions in the UW, after DV. Report UWs with invalid conditions appearing on the Block Status Monitoring window (IPS0697) to System Administrators (SA) for researched by the contractor. A separate ticket is opened for each unique eleven or fourteen-digit DLN present on the report. The reason is one of the following pull document report codes: Reason Code Status Output Verification Audit/ Description DUPDLN SUSPND Duplicate DLN across a block (11-digit DLN) the block is previously output and therefore is a duplicate DLN BADDLN SUSPND DLN is not 14 characters in length not numeric or where characters four or five not valid document code BADDOC SUSPND The block/UW has one or more documents not properly completed in the sub-task. document status between one and 699 (700 is "normal" ) BADTIN SUSPND TIN not nine characters in length not numeric BADUW SUSPND Stand-alone Form 1094-B submission stand-alone Form 1094-C submission, original (not corrected) submission with no valid (non-deleted) documents BADDAT SUSPND Form 1095-X document with a valid status and VOID box checked Form 1094-B with no filer name, box 1 (a required field) question marks on a non-voided document in any field with any documents with a field equaling a status > 10 (not perfected) on a non-voided document DELETE Form 1094-C with no Applicable Large Employer (ALE) member name, box 1 (a required field)
Purging Documents
3.41.267.14 (01-01-2019) Purging Documents Purge from SCRIPS the files including the document images, American Standard Code for Information Interchange (ASCII data), and statistical information once the blocks/UWs of documents process through SCRIPS and reach "accepted" by down-stream processing, and the transmittals have moved to archive. Note: Accepted means the output files and "the returns in those files" clear all error conditions. It is recommended a system purge occur a minimum of two weeks after the output date. Purge only those blocks/UWs available for purge. The system keeps track of blocks/UWs available for purge and only allows you to purge those blocks/UWs. SCRIPS does not allow any blocks waiting for Quality Review (QR) Block Summarization or flagged for Quality Review to purge. Do not purge files for reports before six weeks. Exception: Reports allow deletion after seven working days however six weeks is the preference. A deleted document and/or block/UW is removed from the system when the form type is purged. The remainder of the form types on SCRIPS operate in the same manner. Example: Information return document (UW) is removed when an information return block purge is performed. A purge for the form type is initiated and activated before removal of deleted documents/blocks/UWs from the system. If you open a purge window but do not select any blocks for purge, the deleted documents/blocks/UWs do not leave the system. Until the deletion is properly done documents/blocks/UWs remain on the system. Retained for 30 days after data is verified as converted to tape per Document 12990, Records and Information Management Records Control Schedules, Record Control Schedule (RCS) 29, item 85, Information Returns, the physical documents (UWs scanned in the SCRIPS area). If systemic issues exist for downstream systems a longer period is enforced by headquarters staff.
Terms/Acronyms/Definitions
Exhibit 3.41.267-1 Terms/Acronyms/Definitions TERM/ACRONYM DEFINITION ACA IRP ACA-IRP ACA IRP IRP-ACA Affordable Care Act form types in the Form 1094 (series) or Form 1095 (series) of returns. Reminder: These instructions cover only form types listed in IRM 3.41.267.2.1, Sources Documents. ALE Applicable Large Employer employs 50 or more full-time equivalent employees alone, is the controlling group entity or common owner of multiple business entities with employees as defined under aggregation rules. ALE Member Applicable Large Employer Member is part of a group business entity and employs 50 or more full-time equivalent employees. Alpha Character A character (letter) of the alphabet. Alphanumeric Field A field with both alpha and numeric characters. APO Army Post Office. Application Refers to the system used for form type processed (i.e., IRP, ACA-IRP, Schedule K-1s, Form 940, Form 941, Stand-alone Schedule Rs). ASCII American Standard Code for Information Interchange, is the most common character encoding format for text data in computers and on the internet. Block DLN The first 11-digits of 14-digit document locator number (DLN) consisting of a two-digit file location code, tax class, (tax class is always "5" for ACA IRP), two-digit document type, three-digit Julian day, three-digit block number. Also see DLN. Capture The process of obtaining images of a document for character recognition and operator use. Character Any symbol or alpha (special or numeric) representing information. Character Recognition The process of converting information from paper images to digital data form. Corrected Document A return with the corrected box marked or a filer notation such as the word amended or corrected notated on the return. Cursor A vertical line showing the position where the next entry is keyed. Data Fields Those fields other than entity fields on all documents listed such as: money amounts, dates, indicators, covered individuals, etc. Detail Document Every Form 1095 (series) also referred to as supporting return or document or a child return. DLN (Document Locator Number) A 14-digit document locator number consisting of a two-digit file location code, tax class, (tax class is always "5" for ACA IRP), two-digit document type, three-digit Julian day, three-digit block number, two-digit sequence number and a year digit. Also see Block DLN. DOB (Date of Birth) A date consisting of a month, day and year combination. Caution: Any of the three missing means the remaining combination is not a DOB. Do not enter anything in the field without all three things present or determined. Document Code (Doc Code) The fourth and fifth position of each DLN identifying the type of return the electronic data record has captured. The following is the document code - form number and form title for ACA-IRP. 11 - Form 1094-B, Transmittal of Health Coverage Information Returns 12 - Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns 56 - Form 1095-B, Health Coverage 60 - Form 1095-C, Employer-Provided Health Insurance Offer and Coverage DPO Diplomatic Post Office. EIN An employer identification number (a nine-digit number) typically identifies an entity such as a corporation, a trust, a nonprofit association, or a sole proprietor whose module resides on the business master file. Usually in NN-NNNNNNN format. Employee A recipient listed in Part I of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, issued by their employer (ALE). Entity/Entity Fields The part of the document where the TIN, name, and requests an address present for the entries. Field Specific area provided for data entry. Filer The entity listed on the transmitting Form 1094 (series) always a business entity with a corresponding employer identification number (EIN) or the employer. Flag A question mark used to designate an unrecognizable character, or an error within a field. <F12> also flags a Form 1094 series for re-image. File Location Code (FLC) A two-digit number designed to represent the Service Center where processing action occurs. The action is a transaction representing a return filing or subsequent compliance action. Form Identification Number (Form ID) A six-digit number located at the top right of each page of a SCRIPS ACA IRP document. First two-digits = Document Code Third and fourth digit = Page number of the return Fifth and sixth number = Year the template (layout or landscape placement) is last updated/changed FPO Fleet Post Office. Function Keys The upper row of keys on the SCRIPS keyboard. The function keys <F1> through <F12>. Highlighting A three-dimensional shadowing of a template field used to direct attention to the field. Used in OE to show the current cursor position. Used in DV to show the current cursor position, and the current field with the error. The <Ctrl>-5 function key highlights the corresponding field on the image template. Image Strip A section of the true and complete image magnified and displayed above the template. The image strip displayed is a magnified version of the corresponding field highlighted on the image. Pressing <Ctrl>-3 toggles the image strip on and off. Reminder: The Image Strip will not display if the form required Form Identification (FI) during scanning. Key Combination Keystroke commands requiring two or more simultaneous key presses. Example: Press <Ctrl>-P or post-to-close means to press and hold the <Ctrl> key and then press the <P> key before releasing the <Ctrl> key. Menu A list of operations/options the workstation operator selects. Message Window A window appearing within the main window. It usually appears in the center of the screen. The system uses these windows to relay messages to the operator. NABR Name and Address Block Reader compares the address captured from the scanner and the United States Postal Service database of addresses. Non-Conforming Form A form the scanner cannot recognize. Numeric Character A number ranging from 0 to 9. A digit. Original Document A return without a corrected box marked, amended or corrected notated by the filer on the return. Prompt A message or statement displayed requiring an operator response. Recipient The individual taxpayer listed in Part I of the Form 1095 (series) return who is the employee or responsible individual. Responsible Individual The entity listed in Part 1 of Form 1095-B, Health Coverage, who is the holder, controller or owner of the insurance policy. SA Form 1094C Stand-alone Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, with no details. See IRM 3.41.267.2.1 (1), Source Documents, for more information. Sequence Number/ Serial Number (SN) A two-digit number located at positions 12 and 13 within the DLN and uniquely identifies the document. Sight-Verify Examine a highlighted field in DV. If correct, release the field. If incorrect, correct the field. Also, called verify. Social Security Number (SSN) A nine-digit number issued to an individual by the Social Security Administration. The IRS uses this number to process tax documents and returns. Usually in NNN-NN-NNNN format. Special Characters (symbols) *, &, /, -, %, #, ?, etc. Note: Ampersand "&" is not considered a special character in the name line entry. Status Line A strip of information found along the bottom right side of the main working window below the prompt area. This shows the program number, DLN/SN, document count, and AUTO, Insert and Numeric indicators. Submission A Form 1094 (series) return with associated detail documents, Form 1095 (series), or a SA Form 1094C. Also, called a unit of work (UW). Template A window with fields for data entry. The template mirrors the actual form layout, to the fullest extent possible. TIN Taxpayer Identification Number. Either an EIN or an SSN. Transmittal (Parent document) (Parent return) A Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, filed with the IRS. True and Complete Image The image the system displays for data entry or validation purposes. If available, the system always displays it on the left half of the monitor screen. Unit-of-Work (UW) A group of ACA IRP documents with one Form 1094 (series) transmittal and corresponding Form 1095 (series) returns or one SA Form 1094C as defined. SCRIPS controls a unit-of-work by the Form 1094 (series) 14-digit DLN. YYTY The tax year processed normally current year minus one. YYPY The current processing year normally the current year. Term used to eliminate dates on form prompts changing each year.
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State
Exhibit 3.41.267-2 States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State If the ZIP Code is missing or invalid, add 01 to the first three-digit ZIP Code shown. STATE STATE CODE ZIP CODE RANGE Alabama AL 350-369 Alaska AK 995-999 America Samoa AS 96799 (only) Americas APO/DPO/FPO AA 340 Arizona AZ 850-865 Arkansas AR 716-729 California CA 900-908, 910-961 Colorado CO 800-816 Connecticut CT 060-069 Delaware DE 197-199 District of Columbia DC 200, 202-205 Europe APO/DPO/FPO AE 090-098 Federated States of Micronesia FM 969 Florida FL 320-342, 344, 346, 347, 349 Georgia GA 300-319, 399 Guam GU 969 Hawaii HI 967, 968 Idaho ID 832-838 Illinois IL 600-629 Indiana IN 460-479 Iowa IA 500-528 Kansas KS 660-679 Kentucky KY 400-427 Louisiana LA 700-714 Maine ME 039-049 Marshall Islands MH 969 Maryland MD 206-219 Massachusetts MA 010-027, 055 Michigan MI 480-499 Minnesota MN 550-567 Mississippi MS 368-397 Missouri MO 630-658 Montana MT 590-599 Nebraska NE 680-693 Nevada NV 889-898 New Hampshire NH 030-038 New Jersey NJ 070-089 New Mexico NM 870-884 New York NY 005, 100-149 North Carolina NC 270-289 North Dakota ND 580-588 Northern Mariana Islands MP 969 Ohio OH 430-459 Oklahoma OK 730-732, 734-749 Oregon OR 970-979 Pacific APO/DPO/FPO AP 962-966 Palau PW 969 Pennsylvania PA 150-196 Puerto Rico PR 006, 007, 009 Rhode Island RI 028, 029 South Carolina SC 290-299 South Dakota SD 570-577 Tennessee TN 370-385 Texas TX 733, 750-799 Utah UT 840-847 Vermont VT 050-054, 056-059 Virginia VA 201, 220-246 Virgin Islands VI 008 Washington WA 980-986, 988-994 West Virginia WV 247-268 Wisconsin WI 530-549 Wyoming WY 820-831
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code
Exhibit 3.41.267-3 States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code If the ZIP Code is missing or invalid, add 01 to the first three-digit ZIP Code shown. ZIP CODE RANGE STATE CODE STATE 005, 100-149 NY New York 006, 007-009 PR Puerto Rico 008 VI Virgin Islands 010-027, 055 MA Massachusetts 028, 029 RI Rhode Island 030-038 NH New Hampshire 039-049 ME Maine 050-054, 056-059 VT Vermont 060-069 CT Connecticut 070-089 NJ New Jersey 090-098 AE Europe APO/DPO/FPO 150-196 PA Pennsylvania 197-199 DE Delaware 200, 202-205 DC District of Columbia 201, 220-246 VA Virginia 206-219 MD Maryland 247-268 WV West Virginia 270-289 NC North Carolina 290-299 SC South Carolina 300-319, 399 GA Georgia 320-342, 344, 346, 347, 349 FL Florida 340 AA Americas APO/DPO/FPO 350-369 AL Alabama 370-385 TN Tennessee 386-397 MS Mississippi 400-427 KY Kentucky 430-459 OH Ohio 460-479 IN Indiana 480-499 MI Michigan 500-528 IA Iowa 530-549 WI Wisconsin 550-567 MN Minnesota 570-577 SD South Dakota 580-588 ND North Dakota 590-599 MT Montana 600-629 IL Illinois 630-658 MO Missouri 660-679 KS Kansas 680-693 NE Nebraska 700-714 LA Louisiana 716-729 AR Arkansas 730-732, 734-749 OK Oklahoma 733, 750-779 TX Texas 800-816 CO Colorado 820-831 WY Wyoming 832-838 ID Idaho 840-847 UT Utah 850-865 AZ Arizona 870-884 NM New Mexico 889-898 NV Nevada 900-908, 910-961 CA California 962-966 AP Pacific APO/DPO/FPO 96799 (only) AS American Samoa 967, 968 HI Hawaii 969 PW Palau 969 GU Guam 969 MP Marianna Islands 970-979 OR Oregon 980-986, 988-994 WA Washington 995-999 AK Alaska
Zone Improvement Plan (ZIP) Code, City, and State Exceptions
Exhibit 3.41.267-4 Zone Improvement Plan (ZIP) Code, City, and State Exceptions Exceptions to ZIP where State ZIP Code is five-digits ZIP CITY STATE 75502 Texarkana AR 45275 Airport KY 71749 Junction City LA 03801 Naval Base ME 20331 Andrews AFB MD 06390 Fishers Island NY 73949 Texhoma TX 20041 Dulles Int'l Airport VA 20370 Navy Annex VA 20301 Pentagon VA 49936 Alvin WI
Alphabetical Listing of Major Cities with Major City Codes and Zone Improvement Plan (ZIP) Codes
Exhibit 3.41.267-5 Alphabetical Listing of Major Cities with Major City Codes and Zone Improvement Plan (ZIP) Codes Major City State Code Major City Code ZIP Code Aberdeen SD AD 574 Abilene TX AB 796 Akron OH AK 443 Albany GA AY 317 Albany NY AL 122 Albuquerque NM AQ 871 Alexandria VA AX 223 Alhambra CA YA 918 Allentown PA AW 181 Amarillo TX AM 791 Anaheim CA AH 928 Anchorage AK AN 995-996 Anderson SC AJ 296 Ann Arbor MI AP 481 Arlington TX IA 760 Arlington VA AR 222 Arvada CO AV 800, 804 Asheville NC AS 288 Athens GA AE 306 Atlanta GA AT 303, 311, 399 Atlantic City NJ AC 084 Auburn AL AF 368 Augusta GA AG 309 Augusta ME AA 043 Aurora CO AZ 800 Aurora IL AO 605 Austin TX AU 733, 787 Bakersfield CA BD 933 Baltimore MD BA 212 Baton Rouge LA BR 708 Battle Creek MI QK 490 Beaumont TX BT 777 Bellingham WA BH 982 Berkeley CA BE 947 Bethlehem PA BM 180 Billings MT IB 591 Biloxi MS BL 395 Binghamton NY BC 139 Birmingham AL BI 352 Bismarck ND BB 585 Bloomington IN BQ 474 Bloomington MN BN 554 Boca Raton FL BZ 334 Boise ID BS 837 Bossier City LA BW 711 Boston MA BO 021, 022 Boulder CO BV 803 Bradenton FL BG 342 Bremerton WA BY 983 Bridgeport CT BP 066 Bronx NY BX 104 Brooklyn NY BK 112 Brownsville TX BJ 785 Buffalo NY BF 142 Burlington VT BU 054 Cambridge MA CB 021, 022 Camden NJ CD 081 Canton OH CA 447 Cape Coral FL CF 339 Casper WY CZ 826 Cedar Rapids IA CR 524 Champaign IL CX 618 Chandler AZ YZ 852 Chapel Hill NC CJ 275 Charleston SC CT 294 Charleston WV CW 253 Charlotte NC CE 282 Charlottesville VA CV 229 Chattanooga TN CG 374 Chesapeake VA CP 233 Cheyenne WY CY 820 Chicago IL CH 606-608 Chula Vista CA DV 919 Cincinnati OH CN 452, 459 Clarksville TN YN 370 Clearwater FL CQ 337 Cleveland OH CL 441 Colorado Springs CO CS 809 Columbia SC CU 292 Columbus GA CM 318, 319 Columbus OH CO 430, 432 Corpus Christi TX CC 783, 784 Cranston RI RT 029 Cumberland MD CK 215 Dallas TX DA 752, 753 Davenport IA DP 528 Dayton OH DY 453, 454 Daytona Beach FL DF 321 Dearborn MI DB 481 Decatur IL DT 625 Denver CO DN 800-802 Des Moines IA DM 503, 509 Detroit MI DE 482 Dubuque IA DQ 520 Duluth MN DL 557, 558 Durham NC DU 277 East Lansing MI ET 488 East Orange NJ EO 070 East St Louis IL ES 622 Easton PA EA 180 El Paso TX EP 799, 885 Elizabeth NJ EL 072 Erie PA ER 165 Eugene OR EU 974 Evanston IL EN 602 Evansville IN EV 477 Fairbanks AK FK 997 Fall River MA FR 027 Far Rockaway NY RK 110, 116 Fargo ND FA 581 Fayetteville AR FB 727 Fayetteville NC FN 283 Flint MI FT 485 Florence AL FC 356 Florence SC FE 295 Flushing NY FG 113 Fort Lauderdale FL FL 333 Fort Pierce FL FP 349 Fort Smith AR FS 729 Fort Wayne IN FY 468 Fort Worth TX FW 761 Fresno CA FO 936-938 Gainesville FL GF 326 Gaithersburg MD GG 208 Galveston TX GA 775 Garland TX GD 750 Gary IN GY 464 Gastonia NC GN 280 Glendale AZ GE 853 Glendale CA GL 912 Grand Rapids MI GR 495 Great Falls MT GT 594 Greeley CO GC 806 Green Bay WI GB 543 Greensboro NC GO 274 Greenville SC GV 296 Greenwood MS GW 389 Hackensack NJ HS 076 Hamilton OH HA 450 Hammond IN HM 463 Hampton VA HP 236 Harlingen TX HR 785 Hartford CT HD 061 Harrisburg PA HG 171 Hattiesburg MS HT 394 Helena MT HE 596 Henderson NV HF 890 Hialeah FL HI 330 High Point NC HC 272 Hollywood FL HW 330 Honolulu HI HL 968 Houston TX HO 770, 772 Huntington WV HN 257 Huntington Beach CA HB 926 Huntsville AL HU 358 Independence MO IE 640 Indianapolis IN IN 462 Inglewood CA ID 903 Irvine CA IV 926, 927 Irving TX IR 750 Jackson MS JN 392 Jacksonville FL JV 322 Jamaica NY JA 114 Jamestown NY JM 147 Janesville WI JE 535 Jersey City NJ JC 070, 073 Johnson City TN JH 376 Johnstown PA JO 159 Joliet IL JT 604 Jonesboro AR JB 724 Kalamazoo MI KZ 490 Kansas City KS KA 661 Kansas City MO KC 641, 649 Kennewick WA KW 993 Kenosha WI KE 531 Kingsport TN KP 376 Knoxville TN KN 379 Lafayette IN LF 479 Lafayette LA LL 705 Lake Charles LA LC 706 Lakeland FL LK 338 Lakewood CO LW 801, 802, 804 Lancaster PA LP 176 Lansing MI LG 489 Laredo TX LD 780 Las Cruces NM LZ 880 Las Vegas NV LV 891 Lawrence MA LQ 018 Lewiston ME LT 042 Lexington KY LX 405 Lincoln NE LN 685 Little Rock AR LR 722 Long Beach CA LB 907, 908 Long Island City NY LI 111 Lorain OH LO 440 Los Angeles CA LA 900, 901 Louisville KY LE 402 Lowell MA LM 018 Lubbock TX LU 794 Lynn MA LY 019 Macon GA MA 312 Madison WI MN 537 Manchester NH MR 031 Marietta GA MT 300 Melbourne FL ML 329 Memphis TN ME 375, 381 Meridian MS MD 393 Mesa AZ MZ 852 Metairie LA MI 700 Miami FL MF 330-332 Milwaukee WI MW 532 Minneapolis MN MS 554 Missoula MT MM 598 Mobile AL MO 366 Modesto CA MC 953 Monroe LA MB 712 Montgomery AL MG 361 Muskegon MI MK 494 Naperville IL NP 605 Nashua NH NS 030 Nashville TN NA 372 Newark NJ NK 071 New Bedford MA ND 027 New Brunswick NJ NB 089 New Haven CT NH 065 New Orleans LA NO 701 Newport News VA NN 236 Newton MA NE 024 New York NY NY 100-102 Niagara Falls NY NF 143 Norfolk VA NV 235 Norman OK NR 730 North Charleston SC NC 294 North Hollywood CA NW 916 North Las Vegas NV NT 890 North Little Rock AR NL 721 Oakland CA OA 946 Oak Park IL OP 603 Oceanside CA OE 920 Ogden UT OG 842, 844 Oklahoma City OK OC 731 Olympia WA OL 985 Omaha NE OM 681 Orlando FL OR 328 Oshkosh WI OK 549 Overland Park KS OV 662 Owensboro KY OW 423 Oxnard CA OX 930 Palo Alto CA PQ 943 Parkersburg WV PK 261 Parma OH PZ 441 Pasadena CA PD 910, 911 Paterson NJ PN 075 Pembroke Pines FL PP 330 Pensacola FL PE 325 Peoria AZ PY 853 Peoria IL PL 616 Petersburg VA PG 238 Philadelphia PA PH 190-192 Phoenix AZ PX 850 Pine Bluff AR PB 716 Pittsburgh PA PI 151, 152 Pocatello ID PC 832 Port Arthur TX PA 776 Portland ME PT 041 Portland OR PO 972 Portsmouth NH PS 038 Portsmouth VA PM 237 Providence RI PR 029 Provo UT PV 846 Pueblo CO PU 810 Punta Gorda FL PJ 339 Quincy MA QU 021, 022 Racine WI RA 534 Raleigh NC RL 276 Reading PA RD 196 Reno NV RE 895 Richmond VA RI 231, 232 Riverside CA RS 925 Roanoke VA RO 240 Rochester NY RC 146 Rock Hill SC RH 297 Rockford IL RF 611 Sacramento CA SC 942, 958 Saginaw MI SG 486 Salem OR XR 973 Salinas CA YL 939 Salt Lake City UT XU 841 San Antonio TX SO 782 San Bernardino CA SR 924 San Diego CA SD 921 San Francisco CA SF 941 San Jose CA SJ 951 San Juan PR XJ 009 Santa Ana CA SA 927 Santa Barbara CA SZ 931 Santa Fe NM YF 875 Sarasota FL XS 342 Savannah GA GS 314 Schenectady NY SK 120, 123 Scottsdale AZ YS 852 Scranton PA XC 185 Seattle WA SE 981 Shawnee Mission KS SM 662 Sheboygan WI XB 530 Shreveport LA SH 711 Silver Spring MD SS 209 Sioux City IA SX 511 Sioux Falls SD IQ 571 South Bend IN SB 466 Spartanburg SC SQ 293 Spokane WA SW 992 Springfield IL XL 627 Springfield MA XA 011 Springfield MO XO 657, 658 Springfield OH XH 455 Stamford CT ST 069 Staten Island NY SI 103 St Joseph MO XM 645 St Louis MO SL 631 St Paul MN SU 551 St Petersburg FL SP 337 Sterling Heights MI YH 483 Stockton CA SN 952 Syracuse NY SY 132 Tacoma WA TC 984 Tallahassee FL TL 323 Tampa FL TA 336 Tempe AZ TE 852 Terre Haute IN TH 478 Titusville FL TT 327 Toledo OH TO 436 Torrance CA TN 905 Topeka KS TP 666 Trenton NJ TR 086 Tucson AZ TU 857 Tulsa OK TS 741 Tuscaloosa AL TB 354 Utica NY UT 135 Van Nuys CA VN 913, 914 Vancouver WA VA 986 Virginia Beach VA VB 234 Waco TX WX 767 Warren MI WR 480 Warren OH WO 444 Warwick RI WW 028 Washington DC DC 200, 202-205, 569 Waterbury CT WT 067 Waterloo IA WL 507 West Allis WI WA 532 West Valley City UT WC 841 West Palm Beach FL WP 334 Westminister CO WD 800, 802 Wheeling WV WH 260 White Plains NY WJ 106 Wichita KS WK 672 Wichita Falls TX WF 763 Wilkes-Barre PA WB 187 Williamsport PA WM 177 Wilmington DE WI 198 Wilmington NC WN 284 Winston-Salem NC WS 271 Winter Haven FL WG 338 Worcester MA WE 016 Yonkers NY YK 107 York PA YR 173, 174 Youngstown OH YO 445
Affordable Care Act Information Return Transcription Sheets
Exhibit 3.41.267-6 Affordable Care Act Information Return Transcription Sheets OE/DV Screen Prompt Description Instructions Form 1094-B, Transmittal of Health Coverage Information Returns Tax Year (located top right-hand of form) The tax year is a must enter field entry. Enter the tax year printed/present in the upper right-hand corner of the form. Requires two consecutive matching and valid entries to leave the field. Reminder: Valid tax years: 2025, 2024, 2023, and 2022. Enter "00" if an invalid tax year is present, Then select "yes" when prompted to delete the UW. Note: The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field. Delinquent Indicator First box For Official Use Only Enter the code, if present, from the first For Official Use Only box. Notes: If the box is blank, check if it is present in the top margin of the document. If the code is ≡ ≡ ≡≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡≡ ≡ ≡≡ ≡ ≡≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡, do not enter data in the Delinquent Return Date field. If the code is ≡ ≡≡ enter the valid date in the Delinquent Return Date field. Delinquent Return Date Date stamp in white space of For Official Use Only Enter the date from the IRS received date stamp, if present. If blank, enter the date from the IRS received date stamp in MMDDYY format see the valid dates below. If multiple conflicting received dates present or the received date stamp is circled out leave blank. If the received date stamp is illegible, enter the signature date. If the signature date is illegible, missing, or timely, leave blank. The valid dates: ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡. If the ≡ ≡ is missing and a valid Delinquent Date is present in the Delinquent Return Date field, enter an "≡ ≡ ≡" . If the received date present is not valid remove the "≡ ≡" from the Delinquent Indicator field. Corr. Ind Correspondence Indicator DO NOT enter any codes present from the last two For Official Use Only boxes. Press <Enter>. Line 1- Filer's Name Filer's name Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present delete the UW from the system. Press <Enter>. Line 2-EIN Employer identification number (EIN) Enter the nine-digit EIN present. Caution: Delete the UW by entering all zeros in the EIN field when: - the TIN is missing or is more than or less than nine-digits - any digit is illegible, and the filer entity is not present on the first detail - single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 is entered as the EIN. Line 3-Name of Contact Name of person to contact Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press <Enter>. Line 4-Contact Phone Contact telephone number Enter up to the first twelve numbers if present. Is blank, 7, 10, or 12 numerics. Note: Extensions optional. Line 5-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 6-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 7-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 8-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 9-Total Form 1095-B Total number of Forms 1095-B submitted with this transmittal Enter the number present on the document. OE/DV Screen Prompt Page 1 Description Page 1 Instructions Form 1095-B, Health Coverage - Page 1 Tax Year (located top right-hand of form) The tax year is a must enter field entry. Enter the tax year printed/present in the upper right-hand corner of the form. Requires two consecutive matching and valid entries to leave the field. Reminder: Valid tax years: 2025, 2024, 2023, and 2022. Enter "00" when an invalid tax year is present, or the year does not match the transmittal. Then select "yes" when prompted to delete the return. Note: The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field. Void VOID Box Enter "X" if marked. Note: Consider all data invalid if the filer marks the void box, writes void on the form, marks through the entire form or the SCRIPS operator has voided the return due to duplication within the submission. Corrected CORRECTED Box Enter "X" if marked. Line 1-Resp. First Name First name Enter the first name if present or you can determine it. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial and last name place the entire name in last/full name. Line 1-Resp. Middle Initial Middle initial Enter the middle initial if present or you can determine it. Line 1-Resp. Last/Full Name Last name/Full name Enter the last name. If any character in the name is illegible, enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in this field. Enter suffixes after the last name entry. Line 2-SSN or other TIN Social security number (SSN) Enter the nine-digit SSN or TIN present. If the SSN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Exception: If 50 percent or more of the SSNs in the UW appear redacted, suspend under Supervisor Request. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Exception: If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request. Line 3-Date of Birth Date of birth (if SSN is not available) Enter the date of birth if present in MMDDYYYY format if a complete date is present. Caution: If any of one of MM, DD or YYYY is missing, the remaining combination "is not" a DOB. Do not enter partial data in the field. Line 4-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 5-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 6-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 7-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 8-Origin of Policy Enter letter identifying Origin of the Policy...▸ Enter the alpha character present. Valid characters: "A" through "G." If multiple characters present enter the first valid character. If no valid character is present blank the field. Line 10-Emp. Name Employer name Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. Line 11-EIN Employer identification number Enter the nine-digit EIN present. If the EIN is: Missing enter nothing. Is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Line 12-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 13-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 14-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 15-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 16-Name Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. Line 17-EIN Enter the nine-digit EIN present. If the EIN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Line 18-Contact Phone Contact telephone number Enter up to the first twelve numbers if present. Is blank, 7, 10, or 12 numerics. Note: Extensions optional. Line 19-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 20-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 21-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 22-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 23(a)-Covered Ind. through Line 28(a)-Covered Ind. First Name First name Enter the first name if present or if you can determine it. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial and last name place the entire name in last/full name. Enter suffixes after the last name entry. Line 23(a)-Covered Ind. through Line 28(a)-Covered Ind. Middle Initial Middle initial Enter the middle initial if present or you can determine it. Line 23(a)-Covered Ind. through Line 28(a)-Covered Ind. Last/Full Name Last/Full name Enter the last name. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in this field. Enter suffixes after the last name entry. Note: Instructions repeat for all entries for each covered individual listed on line 23, columns (a, b, c, d, and e) through line 28, columns (a, b, c, d, and e). Line 23(b)-SSN or other TIN through Line 28(b)-SSN or other TIN SSN Enter the nine-digit SSN or TIN present. If the SSN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Exception: If 50 percent or more of the SSNs in the UW appear redacted suspend under Supervisor Request. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Exception: If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 23(c)-DOB through Line 28(c)-DOB DOB (If SSN is not available) Enter the date of birth if present in MMDDYYYY format if a complete date is present. Caution: If any of one of MM, DD or YYYY appear missing the remaining combination "is not" a DOB. Do not enter partial data in the field. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 23(d)-12 Months through Line 28(d)-12 Months Covered all 12 months Enter "X" if marked. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 23(e)-Jan through Line 28(e)-Dec Months of coverage Jan through Dec Enter "X" if marked. Note: Instructions repeat for all entries for each covered individual listed on line 23, columns (a, b, c, d, and e) through line 28, columns (a, b, c, d, and e). Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). OE/DV Screen Prompt Page 3 Description Page 3 Instructions Form 1095-B, Health Coverage - Page 3 SSN Social security number (SSN) Enter the nine-digit SSN or TIN present. Enter a period for illegible characters. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Date of Birth Date of birth (if SSN is not available) Enter the date of birth if present in MMDDYYYY format if a complete date is present. Caution: If any of one of MM, DD or YYYY is missing the remaining combination "is not" a DOB. Do not enter partial data in the field. Line 29(a)-Covered Ind. through Line 40(a)-Covered Ind. First Name First name Enter the first name if present or you can determine it. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in last/full name. Line 29(a)-Covered Ind. through Line 40(a)-Covered Ind. Middle Initial Middle initial Enter the middle initial if present or you can determine it. Line 29(a)-Covered Ind. through Line 40(a)-Covered Ind. Last/Full Name Last name/Full name Enter the last name. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in this field. Enter suffixes after the last name entry. Note: Instructions repeat for all entries for each covered individual listed on line 23 (columns a, b, c, d, and e) through line 40 (columns a, b, c, d, and e). Line 29(b)-SSN through Line 40(b)-SSN SSN or other TIN Enter the nine-digit SSN or TIN present. If the SSN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Exception: If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Exception: If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 29(c)-DOB through Line 40(c)-DOB DOB (If SSN or other TIN is not available) Enter the date of birth if present in MMDDYYYY format if a complete date is present. Caution: If any of one of MM, DD, or YYYY appear missing the remaining combination "is not" a DOB. Do not enter partial data in the field. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 29(d)-12 Months through Line 40(d)-12 Months Covered all 12 months Enter "X" if marked. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 29(e)-Jan through Line 40(e)-Dec Months of coverage Jan through Dec Enter "X" if marked. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). OE/DV Screen Prompt Page 1 Description Page 1 Instructions Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 1 Tax Year (located top right-hand of form) The tax year is a must enter field entry. Enter the tax year printed/present in the upper right-hand corner of the form. Requires two consecutive matching and valid entries to leave the field. Reminder: Valid tax years: 2025, 2024, 2023, and 2022. Enter "00" if an invalid tax year is present. Then select "yes" when prompted to delete the UW. Note: The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field. Corrected CORRECTED Box Enter "X" if marked. Delinquent Indicator First box For Official Use Only Enter the code, if present, from the first For Official Use Only box. Notes: If the box is blank, look for a code in the top margin of the document. If the code is ≡≡ ≡ ≡ ≡≡ ≡≡ ≡ ≡ ≡≡ ≡≡ ≡≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡, do not enter data in the Delinquent Return Date field. If the code is "≡ ≡" , enter the valid date in the Delinquent Return Date field. Delinquent Return Date Date stamp in white space of For Official Use Only Enter the date from the IRS received date stamp, if present. If blank, enter the date from the IRS received date stamp in MMDDYY format see the valid dates below. If multiple conflicting received dates present or the received date stamp is circled out leave blank. If the received date stamp is illegible, enter the signature date. If the signature date is illegible, missing, or timely, leave blank. The valid dates: ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ If the "≡ ≡ ≡" is missing and a valid Delinquent Date is present in the Delinquent Return Date field, enter an "≡ ≡ ≡" . If the received date is not valid remove the "≡ ≡ ≡" from the Delinquent Indicator field. Corr. Ind Correspondence Indicator DO NOT enter any codes present from the last two For Official Use Only boxes. Press <Enter>. Line 1-ALE Member Name of ALE Member (Employer) Enter the full name as shown if present. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If the name is missing and is not present press <Enter>. See IRM 3.41.267.9.2, Name Entry, for more instruction on filers names. Line 2-EIN Employer identification number Enter the nine-digit EIN present. If the EIN is missing, incomplete, invalid, or more than or less than nine-digits then check the first detail document for the EIN. If present enter on Line 2- EIN. If the EIN is not present on the first detail AND line 9 and line 10 appear blank, then enter nine zeros (000000000) to delete the UW. If there is no entry on line 1 and 2 and there is an entry on line 9 and line 10, the system moves the entity on line 9 and line 10 to line 1 and line 2 systemically. If the EIN is a single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 or is more than or less than nine-digits and the correct EIN is not present on the first detail then enter nine zeros (000000000) to delete the UW. Line 3-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 4-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 5-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 6-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 7-Name of Contact Name of person to contact Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press <Enter>. Line 8-Contact Phone Contact telephone number Enter up to the first twelve numbers if present. Is blank, 7, 10, or 12 numerics. Note: Extensions optional. Line 9-Designated Name Name of Designated Government Entity (only if applicable) Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press <Enter>. Note: If there is no ALE data present on Line 1 and 2, and valid data is verified on Line 9 and 10 the designated entity data is moved to the ALE entity data systemically. Line 10-EIN Employer identification number (EIN) Enter the nine-digit EIN present. If there are entries on line 1 and line 2; and the EIN is missing, incomplete, or a single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 or is less than nine-digits press do not enter data. Press<Enter>. If there are entries on line 1 and line 2; and the TIN is more than nine-digits enter the first nine-digits present. If there are entries on line 1 and line 2; and the TIN appears in SSN format enter nothing, press <Enter>. If there is no entry on line 1 and line 2 and the EIN is missing, incomplete, invalid, or more than or less than nine-digits, then enter nine zeros (000000000) to delete the UW. Note: If there is no entry on line 1 and 2 and there is a valid entry on line 9 and line 10 the system moves the entity on line 9 and line 10 to line 1 and line 2 systemically. Line 11-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 12-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 13-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 14-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 15-Name of Contact Name of person to contact Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press <Enter>. Line 16-Contact Phone Contact telephone number Enter up to the first twelve numbers if present. Is blank, 7, 10, or, 12 numerics. Note: Extensions optional. Line 18-Total Form 1095-Cs Total number of Forms 1095-C submitted with this transmittal Enter the number present on the document. Line 19-Authoritative ALE Member Is this the authoritative transmittal for this ALE Member? If "yes," check the box and continue... Enter "X" if marked. Line 20-Total Form 1095-C on behalf of ALE Total number of Forms 1095-C filed by and/or on behalf of ALE Member... Enter the number if present. Numbers only. Leave the entry blank or blank the field if it has alpha characters or words. Line 21-ALE Member of group-Yes Is ALE Member a member of an Aggregated ALE group?... Yes box Enter "X" if the "Yes" box is marked. Line 21-ALE Member of group-No Is ALE Member a member of an Aggregated ALE group?... No box Enter "X" if the "No" box is marked. Line 22-Offer Method Line 22 box "A" Qualifying Offer Method Enter "X" if the box is marked. Line 22-98% Offer Line 22 box "D" 98% Offer Method Enter "X" if the box is marked. OE/DV Screen Prompt Page 2 Description Page 2 Instructions Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 2 Line 23-12 months-Essential Coverage-Yes First check box in column (a) "Yes" row 23 Minimum Essential Coverage Offer Indicator labeled Yes Enter an "X" if the "Yes" box is checked. Line 23-12 months-Essential Coverage-No Second check box in column (a) "No" row 23 Minimum Essential Coverage Offer Indicator labeled No Enter an "X" if the "No" box is checked. Line 23-12 months-Full Time count Column (b) Full-Time Employee Count for ALE Member Enter the number from line 23 column (b) if present. Whole numbers or blank is valid. Do not enter fractions, decimal points, or numbers to the right of a decimal point. Do not round up or down if a fractional or decimal is entered by the filer. Do not enter zeros: 0, 00, 00.00, or, 0.00 etc. Line 23-12 months-Total Emp. Count Column (c) Total Employee Count for ALE Member Enter the number from line 23 column (c) if present. Whole numbers or blank is valid. Do not enter fractions, decimal points, or numbers to the right of a decimal point. Do not round up or down if a fractional or decimal is entered by the filer. Do not enter zeros: 0, 00, 00.00, or, 0.00 etc. Line 23-12 months-Agg. Group Ind Column (d) Aggregated Group Indicator Enter an "X" if the box is checked. Line 24-Jan-Essential Coverage-Yes through Line 35-Dec-Essential Coverage-Yes First check box in column (a) "Yes" row 24 Minimum Essential Coverage Offer Indicator labeled Yes Enter "X" if the "Yes" box is marked. Line 24-Jan-Essential Coverage-No through Line 35-Dec-Essential Coverage-No Second check box in column (a) "No" row 24 Minimum Essential Coverage Offer Indicator labeled No Enter "X" if the "No" box is marked. Note: Instructions repeat for all entries on line 23, All 12 Months, (row 2) to line 35, Dec, (row 14). Line 24-Jan-Full-Time count through Line 35-Dec-Full Time count Column (b) Section 4980H Full-Time Employee Count for ALE Member Enter the number from line 24 column (b) if present. Line 24-Jan-Total Emp. Count through Line 35-Dec-Total Emp. Count Column (c) Total Employee Count for ALE Member Enter the number from line 24 column (c) if present. Line 24-Jan-Agg. Group Ind through Line 35-Dec-Agg. Group Ind Column (d) Aggregated Group Indicator Enter an "X" if the box is checked. OE/DV Screen Prompt Page 3 Description Page 3 Instructions Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 3 Line 36-Name Name of Other ALE Members of Aggregated ALE Group Enter the full name shown if present. Enter a space for any illegible characters. Do not leave two consecutive spaces. Line 36-EIN EIN of Other ALE Members of Aggregated ALE Group Enter the EIN if present. Enter a period for illegible characters. If more than nine-digits enter the first nine-digits. Line 37-65 -Name Name of Other ALE Members of Aggregated ALE Group Use instruction for Line 36-Name for any entries present for Line 37-65-Name. Line 37-65 -EIN EIN of Other ALE Members of Aggregated ALE Group Repeat instruction for Line 36-EIN for any entries present for Line 37-65-EIN. OE/DV Screen Prompt Page 1 Description Page 1 Instructions Form 1095-C, Employer-Provided Health Insurance Offer and Coverage - Page 1 Tax Year (located top right-hand of form) The tax year is a must enter field entry. Enter the tax year printed/present in the upper right-hand corner of the form. Requires two consecutive matching and valid entries to leave the field. Reminder: Valid tax years: 2025, 2024, 2023, and 2022. Enter "00" when an invalid tax year is present, or the year does not match the transmittal. Then select "yes" when prompted to delete the return. Note: The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field. Void VOID Box Enter "X" if marked or if the document is blank. Note: Consider all data on the form invalid if the filer marks the void box, writes void on the form, marks through the entire form or the SCRIPS operator has voided the return due to duplication within the submission. Corrected CORRECTED Box Enter "X" if marked. Line 1-Employee First Name Employee first name Enter the first name if present or you can determine it. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in last/full name. Line 1-Employee Middle Initial Employee middle initial Enter the middle initial if present or you can determine it. Line 1-Employee Last/Full Name Employee last name/full name Enter the last name. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in this field. Enter suffixes after the last name entry. Line 2-SSN Social security number (SSN) Enter the nine-digit SSN present. If the SSN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Exception: If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Exception: If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request. Line 3-Address Street address Enter the street address from the form. If a foreign address, enter the address. Line 4-City City or town Enter the name of the city. If a foreign address is present, enter the city. Line 5-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Line 6-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Line 7-Employer Name Name employer Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If the name is missing and is not present press <Enter>. Line 8-EIN Employer identification number Enter the nine-digit EIN present. If the EIN is missing or is more than or less than nine-digits press <F11> to perfect the EIN. Line 9-Address Street address Enter the street address from the form. If a foreign address, enter the address. Note: If the Address is incomplete or illegible press <F11> to perfect the data. See IRM 3.41.267.9 (10) for information. Line 10-Contact Phone Contact telephone number Enter up to the first twelve numbers if present. Is blank, 7, 10, or, 12 numerics. Note: Extensions optional. Line 11-City City or town Enter the name of the city. If a foreign address is present, enter the city. Note: If the City is incomplete or illegible press <F11> to perfect the data. See IRM 3.41.267.9 (10) for information. Line 12-State/Province State or province Enter the two-character code for the state listed on the document. If a foreign address, enter the province. Note: If the State is incomplete or illegible press <F11> to perfect the data. See IRM 3.41.267.9 (10) for information. Line 13-Zip/Foreign Postal Code Country and ZIP or foreign postal code Enter the five-digit ZIP Code. If missing, press <Enter> to bypass this field. If a foreign address, enter the Country and/or foreign postal code. Note: If the ZIP is incomplete or illegible press <F11> to perfect the data. See IRM 3.41.267.9 (10) for information. Tax Years ≥ 2022 Part II Employee's Age Employee's Age on January 1 Enter the number present. A number 1 through 120 or blank is valid. If no entry is present, or the entry is invalid or illegible blank the field. Example: Delete invalid entries such as 123 years old. Part II-Plan Month Plan Start Month (Enter a two-digit number): Enter the one or two-digit number present. 00 through 12 is valid. Enter 00 if no entry is present. If month is written in (January through December) or an abbreviation for a month (Jan through Dec) enter the corresponding two-digit month. Caution: Scan the entire Plan Start Month area for an entry. Line 14-All 12 months Offer of Coverage (enter required code) Enter the numeric alpha combination present on the document. Valid character combinations: "1A" through "1Z." If multiple codes appear enter the first code combination in the column. Remove invalid combinations. Example: Delete invalid combinations such as "A1" and "11." Line 14-Jan through Line 14-Dec Offer of Coverage (enter required code) Enter the numeric alpha combination present on the document. Valid character combinations: "1A" through "1Z." If multiple codes appear present enter the first code combination in the column. Remove invalid combinations. Example: Delete invalid combinations such as "A1" and "11." Note: Instructions repeat for all entries on line 14, All 12 Months, (column 2) to Dec (column 14). Line 15-All 12 months Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage Enter the dollar amount from line 15 column All 12 Months. Enter the amount in dollars only. Enter a single zero if 0 or 00 is present. Blank the field if a negative figure or a negative 0 is present. Use the space bar to a blank field. Line 15-Jan through Line 15-Dec Employee Required Contribution (see instructions) Enter the dollar amount from line 15 column Jan. Enter the amount in dollars only. Enter a single zero if 0 or 00 is present. Blank the field if a negative figure or a negative 0 is present. Use the space bar for a blank field. Note: Instructions repeat for all entries on line 15, All 12 Months, (column 2) to Dec (column 14). Line 16-All 12 months Section 4980H Safe Harbor and Other Relief (enter code, if applicable) Enter the numeric alpha combination present on the document. Valid character combinations "2A" through "2J." If multiple codes appear enter the first code combination in the column. Remove invalid character combinations. Line 16-Jan through Line 16-Dec Section 4980H Safe Harbor and Other Relief (enter code, if applicable) Enter the numeric alpha combination present on the document. Valid character combinations: "2A" through "2J." If multiple codes appear enter the first code combination in the column. Remove invalid character combinations. Note: Instructions repeat for all entries on line 16, All 12 Months, (column 2) to Dec (column 14). Tax Years ≥ 2022 Line 17 All 12 Months ZIP Code Enter the five-digit ZIP Code. If blank, incomplete, or illegible press <Enter> to bypass this field. If too long enter the first five-digits present. Tax Years ≥ 2022 Line 17-Jan through Line 17-Dec ZIP Code Enter the five-digit ZIP Code. If blank, incomplete, or illegible press <Enter> to bypass this field. If too long enter the first five-digits present. Note: If there is an entry in Line 17 All 12 months, DO NOT enter zip code in boxes for Line 17 Jan Dec, press <Enter>. OE/DV Screen Prompt Page 3 Description Page 3 Instructions Form 1095-C, Employer-Provided Health Insurance Offer and Coverage - Page 3 Employer-Provided Self-Insure Coverage Part III If Employer provided self-insured coverage, check the box and enter the information for... Enter "X" if marked. Line 18(a)-Covered Ind. through Line 30(a)-Covered Ind. First Name Covered individual(s) first name Enter the first name if present or if you can determine it. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in last/full name. Line 18(a)-Covered Ind. through Line 30(a)-Covered Ind. Middle Initial Covered individual(s) middle initial Enter the middle initial if present or if you can determine it. Line 18(a)-Covered Ind. through Line 30(a)-Covered Ind. Last/Full Name Covered individual(s) last name/full name Enter the last name. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces. If it is not possible to determine first, middle initial, and last name place the entire name in this field. Enter suffixes after the last name entry. Line 18(b)-SSN or other TIN through Line 30(b)-SSN or other TIN SSN or other TIN Enter the nine-digit SSN present. If the SSN is more than nine-digits enter the first nine-digits. If any digit is illegible or missing enter a period for the illegible or missing digit. Exception: If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request. If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not enter data. Press <Enter>. Exception: If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request. Exception: If name matches line 1 and the SSN is present on line 2 mirror the entry for line 2. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 18(c)-DOB through Line 30(c)-DOB DOB (If SSN or other TIN is not available) Enter the date of birth if present in MMDDYYYY format if a complete date is present. Caution: If any of one of MM, DD, or YYYY is missing the remaining combination "is not" a DOB. Do not enter partial data in the field. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 18(d)-12 Months through Line 30(d)-12 Months Covered all 12 months Enter "X" if marked. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a). Line 18(e)-Jan through Line 30(e)-Dec Months of coverage Jan through Dec Enter "X" if marked. Caution: Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Valid Characters
Exhibit 3.41.267-7 Valid Characters OE/DV Screen Prompt Valid Characters First Name Alphas (A through Z) Numerics (0 through 9) Hyphen (-) Blank/Space Note: Never enter two consecutive spaces. Maximum 35 characters Caution: Do not enter other characters even if present on the form. Middle Initial Alphas (A through Z) Maximum 1 character Last/Full Name Alphas (A through Z) Numerics (0 through 9) Hyphen (-) Blank/Space Note: Never enter two consecutive spaces. Ampersand (&) Maximum 35 characters Caution: Do not enter other characters even if present on the form. Address Line Alphas (A through Z) Numerics (0 through 9) Hyphen (-) If blank, enter "Z" Slash (/) Asterisk (*) only valid in first position for PO Box Space Note: Never enter two consecutive spaces. Maximum 35 characters Caution: Do not enter other characters even if present on the form. City Line Alphas (A through Z) If blank, enter "ZZZ" Space Note: Space for all special characters in the city/state line with except for an apostrophe. Never enter two consecutive spaces and leave no space for the apostrophe. Maximum 25 characters Caution: Do not enter other characters even if present on the form. State Line Alphas (A through Z) Blank/Space Maximum 2 characters Note: Domestic addresses outweigh foreign addresses in the presence of both. Province Line Alphas (A through Z) Blank/Space Maximum 17 characters Note: Domestic addresses outweigh foreign addresses in the presence of both. ZIP Code Numerics (0-9) Space Maximum five or nine numerics Reminder: The ZIP Code is consistent with the ZIP Code tables listed in Exhibit 3.41.267-2, Exhibit 3.41.267-3, Exhibit 3.41.267-4, and Exhibit 3.41.267-5. Country/Foreign postal code Alphas (A through Z) Numerics (0-9) Maximum 35 characters Reminder: The ZIP Code is consistent with the ZIP Code tables list in Exhibit 3.41.267-2, Exhibit 3.41.267-3, Exhibit 3.41.267-4, and Exhibit 3.41.267-5. Contact Phone Seven, 10 or 12-digits (numbers) Numeric (0-9) Space Date of Birth (DOB, DOB) Numeric (0-9) Format MMDDYYYY Blank/Space Checkboxes Alpha "X" Blank
Unit Production Card (UPC) Inputs for Batch/Block Tracking System (BBTS)
Exhibit 3.41.267-8 Unit Production Card (UPC) Inputs for Batch/Block Tracking System (BBTS) SCRIPS Report Number or Source Report Name Identifier Applicable Program Number BBTS Receipts (Yes or No) BBTS Production (Yes or No) IPS0083 Workstation Operator Statistics Program and Function Summary Report 460-44320 470-44320 480-44320 Yes Yes Receipt and Control release to SCRIPS Local Reports 500-44320 Yes No IPS01119 Run Balance Report Total Records Processed 500-44320 No Yes IPS06440 Throughput Statistics Report Total Documents for all scandrivers minus Total records deleted on IPS01119 450-44320 Yes No IPS01119 Total Records Processed Run Balance Report Data Records Output 450-44320 No Yes
Source: official text