Part IV Covered Individual (Enter the Information for each covered individual(s))
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
23a-28a Name of covered individual(s) Name of each covered individual.
CoveredIndividualGrp CoveredIndividualName PersonFirstNm PersonMiddleNm PersonLastNm SuffixNm
Choice between SSN BirthDt
23b-c-28b-c Covered Individual
The nine-digit social security number (SSN) of each covered individual. ANDThe date of birth of each covered individual—only if SSN is not available.
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Data Mapping for ISS-UI Services/ISS-A2A Web Services
| Form Line Num | 1095-B Data Element | Definition | XML Element Name |
|---|---|---|---|
| 23d -28d | Covered All 12 Months | Check box indicating which months the covered individual was covered for at least one day if the covered individual was not covered for at least one day for all 12 months of the calendar year. |
Choice between CoveredIndividualAnnualInd CoveredIndividualMonthlyIndGrp |
| 23e -28e | Jan | Jan | CoveredIndividualMonthlyIndGrp JanuaryInd |
| 23e -28e | Feb | Feb | FebruaryInd |
| 23e - 28e | Mar | Mar | MarchInd |
| 23e -28e | Apr | Apr | AprilInd |
| 23e - 28e | May | May | MayInd |
| 23e - 28e | Jun | Jun | JuneInd |
| 23e - 28e | Jul | Jul | JulyInd |
| 23e - 28e | Aug | Aug | AugustInd |
| 23e - 28e | Sep | Sep | SeptemberInd |
| 23e - 28e | Oct | Oct | OctoberInd |
| 23e - 28e | Nov | Nov | NovemberInd |
| 23e - 28e | Dec | Dec | DecemberInd |
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Data Mapping for ISS-UI Services/ISS-A2A Web Services
Table 7-9: Form 1094-C
| FormLine Num | 1094-C Data Element | Definition | XML Element Name |
|---|---|---|---|
| None | Unique Submission Id | SubmissionId | |
| None | Original Unique SubmissionId | OriginalUniqueSubmissionId | |
| None | Test Scenario Id | TestScenarioId | |
| None | TIN Request Type Code | TINRequestTypeCd (EmployerInformationGrp) |
|
| None | TIN Request Type Code | TINRequestTypeCd (GovtEntityEmployerInfoGrp) |
|
| None | TIN Request Type Code | TINRequestTypeCd (OtherALEMembersGrp) |
|
| None | Corrected | Indicates if the record is an original (0) or a correction (1) to a record that IRS has already received, processed and accepted. |
CorrectedInd |
| None | Corrected Submission Info Grp |
Information to identify the submission (Form 1094- C) being corrected |
CorrectedUniqueSubmissionId CorrectedSubmissionPayeeName CorrectedSubmissionPayeeTIN |
| None | Tax Year | Identifes the tax year that the forms are being fled for |
TaxYr |
| Part I Applicable Large Employer Member (ALE Member) | Part I Applicable Large Employer Member (ALE Member) | Part I Applicable Large Employer Member (ALE Member) | EmployerInformationGrp |
| 1 | Name of ALE Member (Employer) |
The employer’s name. | BusinessName BusinessNameLine1Txt BusinessNameLine2Txt |
| 2 | Employer identifcation number (EIN) |
The employers 9-digit EIN | EmployerEIN |
| 3 | Street address (includ- ingroom or suite no.) |
The employer’s complete mailing address. |
MailingAddressGrp USAddressGrp AddressLine1Txt AddressLine2Txt |
| 4 | City or town | IRS XML schema provides a choice between using US Address or Foreign |
CityNm USStateCd USZIPCd |
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Data Mapping for ISS-UI Services/ISS-A2A Web Services
| FormLine Num | 1094-C Data Element | Definition | XML Element Name |
|---|---|---|---|
| 5 | State or province | Address. Differences are noted in individual felds on the right. If TransmitterForeignEntityInd is true, then ForeignAddressGrp will be used. |
USZIPExtensionCd Or ForeignAddressGrp AddressLine1Txt AddressLine2Txt CityNm CountryCd - OR CountryNm ForeignProvinceNm ForeignPostalCd |
| 6 | Country and ZIP or foreign postal code |
Country and ZIP or foreign postal code |
Country and ZIP or foreign postal code |
| 7 | Name of person to contact |
Name of the person to contact who is responsible for answering any questions. |
ContactNameGrp PersonFirstNm PersonMiddleNm PersonLastNm S uffxNm |
| 8 | Contact telephone number |
Contact telephone number, including area code, of the person to contact who is responsible for answeringany questions. |
ContactPhoneNum |
| 9 | Name of Designated Government Entity (only if applicable) |
The name of the Designated Government Entity (DGE) if a DGE is fling on behalf of the employer |
GovtEntityEmployerInfoGrp BusinessName BusinessNameLine1Txt BusinessNameLine2Txt |
| 10 | Employer identifcation number (EIN) |
The DGE’s 9-digit EIN | EmployerEIN |
| 11 | Street address (including room or suite no.) |
The DGE’s complete mailing address. IRS XML schema provides a choice between using US Address or Foreign Address. Differences are noted in individual felds on the right. If TransmitterForeignEntityInd is true, then ForeignAddressGrp will be used. |
MailingAddressGrp USAddressGrp AddressLine1Txt AddressLine2Txt CityNm USStateCd USZIPCd USZIPExtensionCd Or ForeignAddressGrp AddressLine1Txt AddressLine2Txt CityNm CountryCd - OR CountryNm ForeignProvinceNm ForeignPostalCd |
| 12 | City or town | City or town | City or town |
| 13 | State or province | State or province | State or province |
| 14 | Country and ZIP or foreign postal code |
Country and ZIP or foreign postal code |
Country and ZIP or foreign postal code |
| 15 | Name of person to contact |
Name of the person to contact who is responsible for answering any questions. |
ContactNameGrp PersonFirstNm PersonMiddleNm PersonLastNm SuffxNm |
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Data Mapping for ISS-UI Services/ISS-A2A Web Services
| FormLine Num | 1094-C Data Element | Definition | XML Element Name |
|---|---|---|---|
| 16 | Contact telephone number |
Contact telephone number, including area code, of the person to contact who is responsible for answering any questions. |
ContactPhoneNum |
| 17 | Reserved | The line is reserved for future use. |
|
| 18 | Total number of Forms 1095-C submitted with this transmittal |
The total number of Forms 1095-C submitted with this Form 1094-C transmittal. |
Form1095CAttachedCnt |
| 19 | Is this the authoritative transmittal for this ALE Member? |
If checkbox is checked, identifes the Form 1094-C transmittal as the Authoritative Transmittal to report aggregate employer level data for the employer. |
AuthoritativeTransmittalInd |
| 20 | Total number of Forms 1095-C fled by and/ on behalf of ALE Member |
The total number of Forms 1095-C that will be fled by and/ employer. |
TotalForm1095CALEMemberCnt |
| 21 | Is ALE Member a member of and Aggregated ALE Group? |
If during any month of the calendar year the employer was a member of an Aggregated ALE Group, check “Yes” checkbox. Otherwise, check the “No” checkbox. |
AggregatedGroupMemberCd |
| 22 | Certifcations of Eligibility | Check each applicable box if the employer meets the eligibility requirements and is using one of the Offer Methods and/ forms of Transition Relief Indicated: A. Qualifying Offer Method D. 98% Offer Method |
QualifyingOfferMethodInd NinetyEightPctOfferMethodInd |
| None | Signature | Not required | JuratSignaturePIN |
| None | Title | Not required | PersonTitleTxt |
| None | Date | The date that the submission is completed. |
SignatureDt |
Guide for Electronically Filing ACA Information Returns for Software Developers and Transmitters 100
FormLine Num
Data Mapping for ISS-UI Services/ISS-A2A Web Services
1094-C Data Definition XML Element Name Element
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