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.
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.