Part I Responsible Individual
Publication 5258 — Guide for Affordable Care Act (ACA) Information Returns (AIR) Submission Composition and Reference Guide · 2026-10-03 edition · updated 2026-10-04 · United States
| 1 | Name of Responsible Individual |
The name of the responsible individual |
Responsible Individual Grp Choice between ResponsibleIndividualName PersonFirstNm PersonMiddleNm PersonLastNm SuffixNm And ResponsibleBusinessName BusinessNameLine1Txt BusinessNameLine2Txt |
|---|---|---|---|
| 2-3 | Employer Covered Individual SSN/ |
Number used to identify the taxpayer. Either an SSN, EIN, ATIN, IRSN or ITIN And The responsible individual’s date of birth – only if Line 2 is blank |
Choice between SSN BirthDt |
| 4 | Street Address (Including Apartment no.) |
The complete mailing address of the responsible individual. IRS XML schema provides a choice between using US Address or Foreign Address. Differences are noted in individual felds on the right. If TransmitterForeign EntityInd is true then ForeignAddressGr p will be used Choice between CountryCd and CountryNm. |
MailingAddressGrp USAddressGrp AddressLine1Txt AddressLine2Txt CityNm USStateCd USZIPCd USZIPExtensionCd Or ForeignAddressGrp AddressLine1Txt AddressLine2Txt CityNm CountryCd - OR CountryNm ForeignProvinceNm ForeignPostalCd |
| 5 | City or Town | City or Town | City or Town |
| 6 | State or province | State or province | State or province |
| 7 | Country and ZIP or Foreign Postal Code |
Country and ZIP or Foreign Postal Code |
Country and ZIP or Foreign Postal Code |
Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters 94
Data Mapping for ISS-UI Services/ISS-A2A Web Services
Form Line 1095-B Data Element Definition XML Element Name Num
Enter letter identifying Health 8 Coverage Origin Code (see instructions for codes)
The letter identifying the origin of the policy: A. SHOP B. Employer- sponsored program C. Gov’t-sponsored program D. Individual market insurance E. Multiemployer F. Miscellaneous Min. Essential Coverage G. Individual Coverage Health Reimbursement Arrangement (IRCHRA)
Part II- Information about Certain Employer-Sponsored Coverage
10 Employer Name Name of theprovider of the coverage.
Employer Identification 11 number (EIN)
Street Address (Including 12 room or suite no.)
13 City or Town
14 State or province
Country and ZIP or Foreign 15 Postal Code
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