Part I - Employee
Line 1: Name of Employee
In Line 1, enter the name of the employee (first name, middle initial, last name).
Line 2: Social Security Number of Employee
In Line 2, enter the social security number (SSN) of the covered employee.
Caution:
Keep in mind that if the IRS is unable to match this Form 1095-C with the individual's SSN, they may be unable to determine your compliance with ACA regulations.
Line 3 to 6: Address of the employee
In Lines 3-6, enter the complete mailing address of the full-time employee-offered coverage, including apartment or A.P.O. Box number if applicable. Keep in mind that a country code is not required for U.S. addresses.