1125 Publ 5223 (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/p5223.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Publication 5223 (Rev. 11-2025) Catalog Number 67909Y

www.irs.gov

Part 1 – SUBSTITUTE STATEMENT TO FORM RECIPIENTS

Section 1.1 – Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Section 1.2 – Electronic Delivery of Recipient Statements . . . . . . . . . . . . . . . . . . . . . 2 Section 1.3 – Form 1095-B Alternative Manner of Furnishing . . . . . . . . . . . . . . . . . . . 3

Part 2 – GENERAL INFORMATION

Section 2.1 – Which Forms Are Covered? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Section 2.2 – Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Section 2.3 – General Requirements for Acceptable Substitute Forms 1094-B,

1095-B, 1094-C, and 1095-C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Part 3 – SPECIFICATIONS FOR SUBSTITUTE FORMS 1094-B, 1095-B, 1094-C, AND 1095-C (ALL FILED WITH THE IRS)

Section 3.1 – Specifications for Forms Filed with the IRS . . . . . . . . . . . . . . . . . . . . . . 7 Section 3.2 – Instructions for Preparing Paper Forms That Will Be Filed With the

IRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Part 4 – EXHIBITS

Section 4.1 – Exhibits of Forms in the Publication . . . . . . . . . . . . . . . . . . . . . . . . . 11

The purpose of this publication is to set forth the tax year 2025 requirements for:

recipients. If you do not use the official IRS form to furnish statements to recipients, you must furnish an acceptable substitute statement. Information presented in substitute statements should be in a point size large enough to be easily read by recipients. To be acceptable, your substitute form(s) and recipient statement(s) must comply with the rules in this publication. Generally, information returns may be furnished electronically with the consent of the recipient. Forms or statements that are furnished to the recipient can be in portrait or landscape format and data fields can be manipulated into any formation as long as they supply the information required by the regulations to the recipient. All data fields must be included on the form. For example, it is not acceptable to furnish a Form 1095-C that does not include Part III. Instructions for the recipient must be included along with the form. Statements can be furnished to recipients by hand. This is important tax information and is being furnished to the Internal Revenue Service.

Truncating recipient identification number on recipient statements. Where permitted, filers may truncate the identification number of a recipient or other covered individuals (SSN, ITIN, or ATIN) on the recipient statement (including substitute and composite substitute statements) furnished to the recipient in paper form or electronically. In addition, on Form 1095-B furnished to the recipient, filers may truncate the identification number of the employer reported in Part II (EIN). The filer’s EIN may not be truncated on the statement. To truncate where allowed, replace the first five digits of the nine-digit number with asterisks (*) or Xs (for example, an SSN xxx-xx-xxxx would appear on the paper recipient statement as ***-**-xxxx or XXX-XX-xxxx). See Treasury Decision 9675, 2014-31 I.R.B. 242, available at IRS.gov/irb/2014-31_IRB/ ar07.html .

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Caution: Truncation is not allowed on any documents the filer files with the IRS. A filer's identification number may not be truncated on any form.

1.2.1 Electronic Recipient Statements

1.2.2 Consent

1.2.3 Format, Posting, and Notification

. If you have received the requisite written consent described below, then you may furnish the statement electronically instead of on paper. This includes furnishing the statement to recipients of Forms 1095-A, 1095-B, and 1095-C.

. The recipient must consent in the affirmative and not have withdrawn the consent before the statement is furnished. The consent by the recipient must be made electronically in a way that shows that he or she can access the statement in the electronic format in which it will be furnished. You must notify the recipient of any hardware or software changes prior to furnishing the statement. A new consent to receive the statement electronically is required after the new hardware or software is put into service. Prior to furnishing the statements electronically, you must provide the recipient a statement with the following statements prominently displayed.

electronically, a paper copy will be provided.

consent applies to every year the statement is furnished or only for the year immediately following the date of the consent.

withdrawal in writing (electronically or on paper). Confirmation of the withdrawal will also be in writing (electronically or on paper).

statements will no longer be furnished to the recipient.

and retain a statement, and a date the statement will no longer be available on the website.

. Additionally, you must do the following.

complies with the guidelines in this document.

before the due date and remains accessible to the recipient on the website through October 15 of that year.

to access and print the statement.

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Caution: Part 1 and Part 2, Sections 2.2 and 2.3.2 are the only parts of this publication that apply to Form 1095-A.

1.3.1 Form 1095-B Alternative Manner of Furnishing

. You will be treated as timely furnishing Form 1095-B if you do the following.

1. Provide a clear and conspicuous notice, in a location on your website that is reasonably accessible to all responsible individuals, stating that responsible individuals may receive a copy of their Form 1095-B upon request. You no longer have to automatically send Form 1095-B to individuals as long as the notice on your website meets all requirements. The notice must include an email address, a physical address, and a telephone number for questions.

2. Post the notice on your website by March 3, 2026, and retain the notice in the same location on your website through October 15, 2026. The due date of March 3 includes the automatic 30-day extension provided by Regulations section 1.6055-1(g)(4).

3. Furnish the Form 1095-B within 30 days of a request. Note: See Regulations section 1.6055-1(g) for more information. This alternative manner of furnishing also applies to the furnishing of Forms 1095-C to non-full-time employees and nonemployees who are enrolled in self-insured health coverage. It does not apply to any other Forms 1095-C. Caution: This relief does not apply to the requirement to file Form 1095-B or Form 1095-C.

This publication contains specifications for these information returns:

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2.1.1 Scope

2.1.2 For More Information

Note: Failure to produce acceptable substitutes of the forms and schedules listed in this publication may result in penalties and delays in processing.

Forms that completely follow the guidelines in this publication and are exact replicas of the official IRS forms do not need to be submitted to the IRS for specific approval. Substitute forms filed with the IRS will be scanned using IRS scanning equipment.

However, software developers and form producers must send a blank copy of their substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C in PDF format to SCRIPS@irs.gov . The purpose is not specifically for approval but to assist the IRS in preparing to scan these forms. Submitters will only receive comments if a significant problem is discovered through this process. Submitters are not expected to delay marketing their forms in order to receive feedback. In no case should Submitters include “live” taxpayer data.

The six-digit form ID code in the upper right corner of Forms 1094-B, 1095-B, 1094-C, and 1095-C identifies the official paper form. Generally, the last two digits of the code represent the last year in which major formatting changes were made to the layout of the forms. Developers must have at least 1/4" of white space around the ID code to ensure that it can be properly read by scanning equipment.

. For purposes of this publication, a substitute form or statement is one that is not published by the IRS. For a substitute form or statement to be acceptable to the IRS, it must conform to the official form, or the specifications outlined in this publication. If the substitute form and recipient copy are exact replicas of the IRS form, then you do not need to submit them for approval. However, you will still need to forward blank copies to SCRIPS@irs.gov . Privately published forms may not state, “This is an IRS approved form.”

In general, section 6011 of the Internal Revenue Code contains requirements for filers of information returns. If you are required to file 10 or more information returns during the year, you must file the forms electronically. The 10-or-more requirement applies in the aggregate to certain information returns that are original returns. For example, a filer may be required to file fewer than 10 Forms 1094-C and 1095-C, but still have an electronic filing obligation based on other kinds of information returns filed. Any corrected information returns must be filed in the same manner as the original information returns were required to be filed. For example, if the original return was required to be filed electronically, then any corrected returns must also be filed electronically.

. Further information can be found in Pub. 5164, Test Package for Electronic Filers of Affordable Care Act (ACA) Information Returns (AIR), and Pub. 5165, Guide for Electronically Filing Affordable Care Act (ACA) Information Returns for Software Developers and Transmitters.

Note: Further information impacting Pub. 5223, such as issues arising after its final release, will be posted on IRS.gov at IRS.gov/Pub5223 .

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Form recipient. This means the person to whom you are required by law to furnish a copy of the official form or information statement. The form recipient is referred to as a responsible individual on Form 1095-B and an employee on Form 1095-C.

Filer. The filer is the person or organization required by law to file a form listed under Which Forms Are Covered? with the IRS.

Substitute form. This means a paper substitute of an official form listed under Which Forms Are Covered? that totally conforms to the provisions in this publication.

Substitute form recipient statement. This statement is a paper statement of the information reported on Forms 1095-A, 1095-B, and 1095-C. This statement must be furnished to a person (form recipient), as defined under the applicable provisions of the Internal Revenue Code and the applicable regulations.

2.3.1 Introduction

2.3.2 Logos, Slogans, and Advertisements

. Paper substitutes for Forms 1094-B, 1095-B, 1094-C, and 1095-C that totally conform to the specifications listed in this publication may be privately printed and filed as returns with the IRS. The reference to the Department of the Treasury – Internal Revenue Service should be included on all such forms.

If you are uncertain of any specification and want it clarified, you may submit an email citing the specification, stating your understanding and interpretation of the specification, and attaching an example of the form (if appropriate) to substituteforms@irs.gov . Please enter “Substitute Forms” on the subject line.

You may also mail a letter to:

Internal Revenue Service Attention: Substitute Forms Program C:DC:TS:CAR:MP:P:TP 1111 Constitution Ave. NW, IR-6554 Washington, DC 20224

Note: Allow at least 30 days for the IRS to respond.

Forms 1094-B, 1095-B, 1094-C, and 1095-C are subject to annual review and possible change. Therefore, filers are cautioned against overstocking supplies of privately printed substitutes.

. Caution: Logos, slogans, and advertisements are not allowed on copies filed with the IRS.

Some Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C that include logos, slogans, and advertisements may not be recognized as important tax documents. A recipient may not recognize the importance of the recipient copy for tax reporting purposes due to the use of logos, slogans, and advertisements. Thus,

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2.3.3 Penalties

the IRS has determined that logos, slogans, and advertising will not be allowed on Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C or any recipient copies, with the following exceptions:

trademark, service mark, or symbol of the filer or employer, an embossment, or watermark on the information return and recipient copies that is a representation of the name, a primary trade name, trademark, service mark, or symbol of the filer or employer;

normally used by the filer or employer and used in a non-intrusive manner; and

recipient to recognize, understand, and use the tax information on the recipient copies.

The IRS efile logo on the IRS official recipient copies may be included, but it is not required, on any of the substitute form copies.

The information return and recipient copies must clearly identify the filer or employer name associated with its employer identification number.

Logos and slogans may be used on permissible enclosures, such as a check or account statement, but cannot be used on information returns and recipient copies.

As indicated, Forms 1095-A, 1094-B, 1095-B, 1094-C, and 1095-C are subject to annual review and possible change. If you have comments about the restrictions on including logos, slogans, and advertising on information returns and recipient copies, send your comments to:

Internal Revenue Service Attention: Substitute Forms Program C:DC:TS:CAR:MP:P:TP 1111 Constitution Ave. NW, IR-6554 Washington, DC 20224

or email substituteforms@irs.gov .

. Proposed substitutes must be exact replicas of the official IRS form with respect to layout and content. Proposed substitutes that do not conform to the specifications in this publication are not acceptable. Further, if you file such forms with the IRS, you may be subject to a penalty for failure to file a correct information return under section 6721 of the Code. The amount of the penalty is based on when you file the correct information return. The penalty is:

due date of the return; maximum penalty—$683,000 per year ($239,000 for small businesses);

after the due date but by August 1; maximum penalty—$2,049,000 per year ($683,000 for small businesses); and

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required information returns; maximum penalty—$4,098,500 per year ($1,366,000 for small businesses).

There are exceptions for reasonable cause and certain de minimus errors. For more information, see Notice 2017-09, 2017-4 I.R.B. 542, at IRS.gov/irb/ 2017-04_IRB/ar11.html .

3.1.1 General Requirements

3.1.2 Color and Paper Quality

. Form identifying numbers (for example, 560118 for Form 1095-B) must be printed in nonreflective black carbon-based ink, on each page (including instructions), in print positions 100 through 106, ¹ /2 inch from the top and right-side margin, using an OCR A font. All check boxes on the form must be 10-point boxes with 1/8 inch of white space around each box. Fillable fields must be in Helvetica bold 10-point font. Measurements are generally from the left edge of the paper. Forms must be printed in landscape format and set to print to “actual size.”

. Color and paper quality for substitute forms as specified by JCP Code 0-25, dated November 29, 1978, must be white 100% bleached chemical wood, optical character recognition (OCR) bond produced in accordance with the following specifications.

Note: Reclaimed fiber in any percentage is permitted provided the requirements of this standard are met.

Acidity: Ph value, average, not less than 4.5

Basis Weight: 17 x 22-500 cut sheets 18-20

Metric equivalent–g/m ² 75

A tolerance of ±5 pct. is allowed.

Stiffness: Average, each direction, not less than-milligrams 50

Tearing strength: Average, each direction, not less than-grams 40

Opacity: Average, not less than-percent 82

Thickness: Average-inch 0.0038

Metric equivalent-mm 0.097

A tolerance of +0.0005 inch (0.0127 mm) is allowed. Paper cannot vary more than 0.0004 inch (0.0102 mm) from one edge to the other.

Porosity: Average, not less than-seconds 10

Finish (smoothness): Average, each side-seconds 20-55

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3.1.3 Paper Content

3.1.4 OCR Specifications

3.1.5 Typography

For information only, the Sheffield equivalent-units 170-100

Dirt: Average, each side, not to exceed-parts per million 8

. The paper must be:

. You must initiate or have a quality control program to assure OCR ink density. Readings will be made when printed on approved 20 lb. white OCR bond with a reflectance of not less than 80%. Black ink must not have a reflectance greater than 15%. These readings are based on requirements of the BancTec IntelliScan XDS scanner.

The following testers and ranges are acceptable.

Important information: The forms produced under these specifications must be guaranteed to function properly when processed through High-Speed BancTec IntelliScan XDS scanners. Forms require precision spacing, printing, and trimming.

Density readings on the solid J-6983 must be between the ranges of 0.95 to 0.90. The optimal scanning range is 0.93. Density readings on the solid black must be between the ranges of 112 to 108. The optimal scanning range is 110.

Note: The readings are taken using an Ex-Rite 500 series densitometer, in Status T with Obsolute or – paper setting under an Illuminate 5000 Kelvin Watt Light. You must maintain print contrast specification of ink and densitometer reflectivity reading throughout entire production run.

using the MacBeth PCM-II tester on the “C” scale must range from .01 minimum to .06 maximum.

tester on the Infra-Red (IR) scale must range from .12 minimum to .21 maximum. White calibration disc must be 100%. Sensitivity must be set at one (1).

. Type must be substantially identical in size and shape to the official form. The preferred type face is Helvetica; however, the following are acceptable alternatives: Arial, Calibri, and Times New Roman. See Section 3.2.2 for information on the type face used for data entered on the form. All rules are either ¹ /2-point or ³ /4-point.

Note: The form identifying number must be nonreflective carbon-based black ink in OCR A font and printed in the same position.

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3.1.6 Source Code

3.1.7 Required Inclusions/ Exclusions

. Paper substitute Forms 1094-B, 1095-B, 1094-C, and 1095-C that are exact replicas or totally conform to the specifications in this publication do not need a source code. A source code should only be requested if the substitute form will differ from the official IRS form.

Substitute recipient copies that differ from the IRS copy must have a source code affixed to the bottom left corner of the first page of the substitute form as described in Pub. 1167, General Rules and Specifications for Substitute Forms and Schedules. You must request a source code from the substitute forms unit by sending an email to substituteforms@irs.gov .

. You must include the OMB number in the same location as on the official form.

The following Privacy Act and Paperwork Reduction Act Notice phrase must be printed on the forms as follows. It must also be printed on the copy of the form retained by the filer.

version of the Instructions for Forms 1094-B, 1095-B, 1094-C, and 1095-C.”

A postal indicia may be used if it meets the following criteria.

The printer’s symbol (GPO) must not be printed on the substitute. Instead, the employer identification number (EIN) of the form's printer must be entered in the bottom margin on the face of each individual form, or on the bottom margin on the back of each form.

Provide a check sheet along with your submission to the substitute forms unit at substituteforms@irs.gov . List the form(s) you are submitting for review and approval. Pub. 1167 provides more detail on how submissions should be submitted.

The Catalog Number (Cat. No.) shown on the forms is used for IRS distribution purposes and should not be printed on any substitute forms.

The form must not contain the statement “IRS approved” or any similar statement.

3.2.1 Recipient Information

. The fillable fields for the form recipient's name, street address, city or town, state or province, country, and ZIP or foreign postal code, and telephone number (if required) should be typed or machine printed in black ink in the same format as shown on the official IRS form.

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3.2.2 Specifications and Restrictions

The following rules apply to the form recipient's name(s).

Although handwritten forms will be accepted, the IRS prefers that filers type or machine print data entries. Also, filers should insert data as directed by shading, or in the middle of blocks, well separated from other printing and guidelines, and take measures to guarantee clear, dark black, sharp images.

Truncating recipient identification number on recipient statements. Where permitted, filers may truncate the identification number of a recipient or other covered individuals (SSN, ITIN, or ATIN) on the recipient statement (including substitute and composite substitute statements) furnished to the recipient in paper form or electronically. In addition, on Form 1095-B furnished to the recipient, filers may truncate the identification number of the employer reported in Part II (EIN). The filer’s EIN may not be truncated on the statement. To truncate where allowed, replace the first five digits of the nine-digit number with asterisks (*) or Xs (for example, an SSN xxx-xx-xxxx would appear on the paper recipient statement as ***-**-xxxx or XXX-XX-xxxx). See Treasury Decision 9675, 2014-31 I.R.B. 242, available at IRS.gov/irb/2014-31_IRB/ ar07.html .

Caution: Truncation is not allowed on any documents the filer files with the IRS. A filer's identification number may not be truncated on any form.

. Machine-printed forms should be printed using a 6 lines/inch option and should be printed in 10-pitch pica (10 print positions per inch) or 12-pitch elite (12 print positions per inch). Proportional spaced fonts are unacceptable.

Substitute forms prepared in continuous or strip form must be burst and stripped to conform to the size specified for a single sheet before they are filed with the IRS.

Fillable fields must be printed using Helvetica bold 10-point font. If data does not fit using 10-point font, use no less than 8-point font for optimal data recognition. If data will not fit in the space designated for each field, despite making the allowable adjustments, then users can allow information to wrap in a single field. The data for a field must be contained in that specific field and not bleed into adjacent fields.

or other special characters in the numbered money boxes.

the recipient name line.

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3.2.3 Where To File

3.2.4 OMB Requirements for All Forms in This Publication

the form identifying number may impair the IRS’s ability to machine scan the type of documents.

. Mail completed paper forms to the IRS service center shown in the instructions for Forms 1094-B, 1095-B, 1094-C, and 1095-C. Specific information needed to complete the forms mentioned in this publication are given in the specific form instructions.

. The Paperwork Reduction Act (the Act) of 1995 (Public Law 104-13) requires that:

form contains (in or near the upper right corner) the OMB approval number, if any. (The official OMB numbers may be found on the official IRS printed forms and are also shown on the forms in the exhibits in Part 4 .); and

1. Why the IRS needs the information,

2. How it will be used, and

3. Whether or not the information is required to be furnished to the IRS.

Any substitute form or substitute statement to a recipient must show the OMB number exactly as it appears on the IRS form. This information must be provided to any users of official or substitute IRS forms or instructions.

4.1.1 Purpose

4.1.2 Guidelines

. Exhibits A through H illustrate some of the specifications that were discussed earlier in this publication. The dimensions apply to the actual size forms, but the exhibits have been reduced in size. The dimensions listed on the exhibits apply to all forms in this publication.

. Keep in mind the following guidelines when printing substitute forms.

illustrated in the exhibits.

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4.2 Exhibits

. The following exhibits provide specifications for the forms listed in Section 2.1.

Exhibit A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1094-B

Exhibit B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1095-B, page 1

Exhibit C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1095-B, page 3

Exhibit D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1094-C, page 1

Exhibit E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1094-C, page 2

Exhibit F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1094-C, page 3

Exhibit G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1095-C, page 1

Exhibit H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Form 1095-C, page 3

Exhibit A Must be in Landscape Form 1094-B

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Exhibit B Must be in Landscape Form 1095-B Page 1

Exhibit C Must be in Landscape Form 1095-B Page 3

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Exhibit D Must be in Landscape Form 1094-C Page 1

Exhibit E Must be in Landscape Form 1094-C Page 2

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Exhibit H Must be in Landscape Form 1095-C Page 3

600320 Form 1095-C (2025) Page 3

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Form 1095-C (2025)

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