Section 267. Affordable Care Act Information Return Processing on Service Center…

(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.

(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.

James L. Fish Director, Submission Processing Taxpayer Services

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.

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.

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.

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 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.

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.

Locate terms and acronyms in this instruction in Exhibit 3.41.267-1, Terms/Acronyms/Definitions.

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.

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.

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

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.

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."

Keystroke Combinations:

Carets enclose keystroke combinations (e.g., ).

A hyphen separates multiple keystroke combinations (e.g., -M). This means hold down the 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.

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.

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.

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.

Form 1094 (series) return must still undergo image only process for the retention copy.

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 "≡ ≡ ≡ ≡" .

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.

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.

The scanner does not reject any pages except mechanical rejects.

Press the 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.

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.

No entry is "valid" for use with this program.

Remove any entry present in the screen input if noticed.

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.

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.

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.

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.

SCRIPS does not process tax years equal to the processing year minus five or more.

You cannot determine the tax year of the submission.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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

Release the Print Screen button first and then the shift key. The printing action begins upon the release of the Print Screen keystroke.

-M

Enlarges the size of the scanned image appearing above the entry field.

-L

Reduces the size of the scanned image appearing above the entry field.

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.

The FI option appears grayed out on the Workstation Main Menu if not in your profile.

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 -P key combination to set post-to-close and press to suspend, before entering any data, to return to the Form Identification Selection Menu.

Notify your supervisor.

Press the -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.

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)

Do not use.

2

Form 1095-B pg3 (560318)

5

Form 1095-C pg3 (600320)

6

Form 1095-C pg3 (600318)

Do not use.

Press 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 . 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 --, -, or -- key combination.

Press the -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.

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.

This option is grayed on the Workstation Main Menu if it is not in your profile.

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 as prompted or press -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 -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 key to release a document and display the next template.

Press the -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.

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.

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.

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.

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 as prompted or press -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 key to cancel the entry. You return to the IRP ACA OE Paper Selection Menu.

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.

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.

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.

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 and keys to end OE from paper or press -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.

For OE Image, when you release the last document in a UW, this also releases the UW:

If -P is pressed before releasing the UW, the OE Selection Menu opens.

If -P is not pressed, another UW opens.

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 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.

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 -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.

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.

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.

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.

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.

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 --.

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 -P post-to-close, press to suspend and return to the DV Selection Menu. Notify supervisor.

After entering the last field on document, if AUTO is off, press the key to release the document and display the next template.

Press the -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.

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.

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 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.

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 -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.

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 -4 (Override key) is not enabled for field character type, tax year, or invalid date of birth (MMDDYYYY).

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.

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 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.

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 up and down arrows. Moving an address to the correct field does not require updates to standard abbreviations.

The - 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).

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 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

NABR does not appear in the bottom right-hand corner in the conditions listed above.

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.

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.

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.

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.

If the name of the street is a direction, the direction is spelled out. Do not abbreviate street names.

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.

West Miami enter as W MIAMI, not W MF.

If the city has numerics, enter as alphas.

29 Palms enter as TWENTY NINE PALMS.

Abbreviate only the last designation present if multiple street designations appear.

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.

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 . 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 key in the ZIP Code field. The system generates the default ZIP Code for this state.

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 .

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:

ENTER AS:

APO New York, NY 091XX

APO AE 091XX

FPO San Francisco, CA 962XX

FPO AP 962XX

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.

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 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.

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 to clear the field, and then press the space bar then .

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 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" (; 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 to clear the field and then press the space bar then .

If a code or other non-monetary entry is present in a monetary field press to clear the field, then press the space bar followed by .

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.

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.

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.

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.

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.

The 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

SCRIPS scanning function for image only processing and archiving is done for submissions processed for re-imaging (the 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.

This option is not present on the Data Validation Function Menu if it is not in your profile.

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.

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 to remove the document from further processing.

Press -- or -- 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.

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.

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

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

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

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.

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

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

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.

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)

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

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:

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

Marked "Remove" in FI.

INVALID TAX YEAR

Invalid Tax Year

PULL IMAGE ONLY

Marked "Remove" in Image Only

Requires rescanning.

PULL

is pressed to remove document in OE/DV

PULL STANDALONE Form 1094-B

Stand-alone Form 1094-B

PULL IMAGE ONLY - NO DLN

is pressed in Image Only on recognized document

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

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

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

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 -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 -A key combination again to deselect all blocks if you choose to not perform updates on the selected blocks.

Press the -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.

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)

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.

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.

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.

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.

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.

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.

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. 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 through .

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 -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 -3 toggles the image strip on and off.

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.

Press -P or post-to-close means to press and hold the key and then press the

key before releasing the 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.

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.

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

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

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

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

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.

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.

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 .

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 .

Line 2-EIN

Employer identification number (EIN)

Enter the nine-digit EIN present.

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 .

Line 4-Contact Phone

Contact telephone number

Enter up to the first twelve numbers if present. Is blank, 7, 10, or 12 numerics.

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 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.

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.

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.

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.

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 .

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.

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 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 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.

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 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.

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.

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 .

If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.

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.

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.

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.

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.

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).

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 .

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.

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.

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.

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 .

If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.

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.

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.

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.

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.

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.

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.

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 .

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 .

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 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 .

Line 8-Contact Phone

Contact telephone number

Enter up to the first twelve numbers if present. Is blank, 7, 10, or 12 numerics.

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 .

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.

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 .

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.

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 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 .

Line 16-Contact Phone

Contact telephone number

Enter up to the first twelve numbers if present. Is blank, 7, 10, or, 12 numerics.

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.

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.

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.

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.

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.

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 .

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 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 .

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 to perfect the EIN.

Line 9-Address

Street address

Enter the street address from the form. If a foreign address, enter the address.

If the Address is incomplete or illegible press 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.

Extensions optional.

Line 11-City

City or town

Enter the name of the city. If a foreign address is present, enter the city.

If the City is incomplete or illegible press 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.

If the State is incomplete or illegible press 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 to bypass this field. If a foreign address, enter the Country and/or foreign postal code.

If the ZIP is incomplete or illegible press 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.

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.

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.

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.

Delete invalid combinations such as "A1" and "11."

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.

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.

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 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 to bypass this field. If too long enter the first five-digits present.

If there is an entry in Line 17 All 12 months, DO NOT enter zip code in boxes for Line 17 Jan Dec, press .

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.

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 .

If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.

If name matches line 1 and the SSN is present on line 2 mirror the entry for line 2.

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.

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.

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.

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.

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

Valid Characters

First Name

Alphas (A through Z)

Numerics (0 through 9)

Hyphen (-)

Blank/Space

Never enter two consecutive spaces.

Maximum 35 characters

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

Never enter two consecutive spaces.

Ampersand (&)

Maximum 35 characters

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

Never enter two consecutive spaces.

Maximum 35 characters

Do not enter other characters even if present on the form.

City Line

Alphas (A through Z)

If blank, enter "ZZZ"

Space

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

Do not enter other characters even if present on the form.

State Line

Alphas (A through Z)

Blank/Space

Maximum 2 characters

Domestic addresses outweigh foreign addresses in the presence of both.

Province Line

Alphas (A through Z)

Blank/Space

Maximum 17 characters

Domestic addresses outweigh foreign addresses in the presence of both.

ZIP Code

Numerics (0-9)

Space

Maximum five or nine numerics

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

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

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

More Internal Revenue Manual

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