Part 3. Submission Processing
Chapter 41. OCR Scanning Operations
Section 267. Affordable Care Act Information Return Processing on Service Center Recognition/Image System (SCRIPS)
3.41.267 Affordable Care Act Information Return Processing on Service Center Recognition/Image System (SCRIPS)
Manual Transmittal
November 20, 2020
Purpose
(1) This transmits revised IRM 3.41.267, Optical Character Recognition (OCR) Scanning Operations, Affordable Care Act Information Return Processing on Service Center Recognition/Image System (SCRIPS).
Material Changes
(1) IRM 3.41.267.2.1 (1) Updated valid tax years to reflect 2017 through 2020 to reflect programming changes.
(2) IRM 3.41.267.3.1 (2) Removed tax year 2016 no longer processed and added new tax year 2020 to process to the Delinquent Return Date table to reflect programming changes.
(3) IRM 3.41.267.3.2 (5) Added instruction to return boxes/batches of work with excessive unprocessable forms with missing or invalid Form Identification Numbers (Form IDs) to Information Return Program (IRP) Sort Unit to reduce unprocessable work.
(4) IRM 3.41.267.4.1 (1)
Updated invalid prior year statement updated to equal current processing year minus five or more. IPU 20U0290 issued 02-19-2020
Added missing Form IDs to the invalid listing.
(5) IRM 3.41.267.6.2
(2) Updated form identification menu options to reflect the new screen options for current years processed to reflect programming changes.
(4) Added suspend to supervisor instruction for form types other than Affordable Care Act (ACA) documents routed in error to allow for delete of option X on the Form Identification function.
(6) IRM 3.41.267.8.1
(2) Added Data Validation (DV) Selection Menu options in the instruction to reflect programming.
(3) Listed DV Image Selection Menu options in the instruction to reflect programming.
(7) IRM 3.41.267.8.2 (2) Added instruction on menu option Data Validation 2 (DV2) to use when correcting threshold validations on i paper documents already entered through OE and DV reflecting system programming.
(8) IRM 3.41.267.9
(4) Updated example of invalid dates equal to 120 years to reflect the new year to reflect programming changes.
(16) Added tax year 2019, 2018, and 2017 to Form 1095-C, page 3 cross validation table to reflect programming changes.
(17) Added threshold validation DV2 to the general instruction reflecting system programming.
(9) IRM 3.41.267.12.7 (4) and (5) Added instruction to generate the production report weekly and email the report to the Project Management Office (PMO) by close of business on the first day of the work week as requested by PMO. IPU 20U0290 issued 02-19-2020
(10) Exhibit 3.41.267-6
Updated valid tax years for processing.
Updated delinquent return date ranges.
Updated OE/DV Screen Prompts column to reflect programming updates.
Added tax year at the top of each screen prompt when tax year specific prompt is present to reflect programming changes.
Updated Form 1095-B, Health Coverage, line 8, Origin of Policy, valid entries for each tax year to reflect programming changes.
Deleted fields for tax year 2016 from the transcription tables to reflect programming changes.
Added new fields for tax year 2020 revision of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, to the instruction to reflect programming changes. Added tax year 2020 at the top of the screen prompts column to reflect programming changes.
Added new table for page 3 of tax year 2020 Form 1095-C to reflect programming changes.
Added tax years 2019, 2018 and 2017 to the existing table for page 3 of Form 1095-C to reflect programming changes.
(11) Exhibit 3.41.267-7 Removed tax year 2016 from the instruction to reflect programming dropped from the system.
(12) Editorial corrections, consistency changes, and cross reference updates made throughout the instruction.
Effect on Other Documents
IRM 3.41.267 dated October 29, 2019, (effective January 01, 2020) is superseded. This IRM incorporates IRM procedural update (IPU) 20U0290 issued 02-19-2020.
Audience
Instructions used by Wage and Investment, SCRIPS Processing Site employees working paper submitted Affordable Care Act information returns.
Effective Date
(01-01-2021)
James L. Fish
Director, Submission Processing
Wage and Investment Division
3.41.267.1(01-01-2020)
Program Scope and Objectives
This program provides human intervention for data verification of electronic data record created by optical recognition engines for the purpose of data capture from paper returns filed with the IRS.
Purpose: This IRM provides instruction on processing of paper filed Affordable Care Act information returns (ACA-IRP) on the Service Center Recognition/Image Processing System (SCRIPS). This instruction converts taxpayer data reported to electronic data records to fulfill the filing requirement.
Audience: Submission Processing Data Conversion Operation personnel including: data entry clerks, peripheral operators, clerks, leads and supervisors. These instructions apply to all campuses.
Policy Owner: The Director of Submission Processing.
Program Owner: Mail Management Data Conversion Section, Paper Processing Branch (an organization within Submission Processing).
Primary Stakeholders: Service and Enforcement, ACA Implementation, Compliance Strategy and Policy and Small Business/Self Employed (SB/SE), Operations Business Support, and Office of Servicewide Penalties.
Program Goals: The goal of this program is to convert processable paper filed Affordable Care Act information documents to electronic data records.
3.41.267.1.1(01-01-2018)
Background
Filers send paper information returns to IRS to fulfill their filing requirement and provide their taxpayer identification number (TIN). The IRS must convert the information present on the paper filings to an electronic data record. Employees input and validate the data present and IRS systems for these records during conversion to electronic data records.
3.41.267.1.2(01-01-2018)
Authority
Authority for these procedures is found in Title 26 of the United States Code (USC) or more commonly known as the Internal Revenue Code (IRC). The following list authorities related to this program:
Information Reporting on Health Coverage by Insurers IRC 6055
Information Reporting on Health Coverage by Employers IRC 6056
Failure to File a Correct Information Return IRC 6721
Note:
The above list is not all inclusive of the various updates to the IRC.
3.41.267.1.3(01-01-2018)
Responsibilities
The Director, Submission Processing approves and authorizes issuance of this IRM.
The Planning and Analysis staff provides feedback and supports local management to achieve and effectively monitor scheduled goals.
The Operations manager secures, assigns and provides training to perform the instruction.
The team manager assigns, monitors and controls the workflow to complete the work timely.
The employee applies the instruction to the SCRIPS system to convert paper data to an electronic data record.
3.41.267.1.4(01-01-2020)
Program Management and Review
Program Reports: Management uses these reports to monitor daily (IPS0698 throughout each work day) and weekly status of the program to completeness. Below is a list of reports used:
IPS0083, Workstation Operator Statistics Program and Function Summary Report
IPS0698, Workflow Status
IPS01119, Run Balance Report
IPS06440, Throughput Statistics Report
PCC 2240, Daily Production Report - Program Sequence
PCC 6040, SC WP&C Performance and Cost Report
PCC 6240, SC WP&C Program Analysis Report
PCB 0440, Daily Workload and Staff Hours Schedule
PCB 0540, Weekly Workload and Staffing Schedule
Program Effectiveness: Management measures goals using standard documents per hour reports. Each function must complete inventory prior to the program completion date stated in IRM 3.30.123, Work Planning and Control - Processing Timeliness: Cycles, Criteria, and Critical Dates. Local Management conducts and monitors quality reviews and takes corrective action taken to ensure quality products. A managerial or product review in Data Validation function is performed each week on every employee and entered in Embedded Quality for Submission Processing System (EQSP). Managerial and product review supplement the quality review process.
Annual Review: Review the processes included in this manual annually to ensure accuracy and promote consistent tax administration.
3.41.267.1.5(01-01-2018)
Program Controls
Management uses unit production cards (UPCs) to measure and record activity in each function of this program.
Management can use local reports to establish information for maintaining daily program control. Local reports never replace the established official reports.
3.41.267.1.6(01-01-2018)
Terms/Definitions/Acronyms
Located terms and acronyms in this instruction in Exhibit 3.41.267-1, Terms/Acronyms/Definitions.
3.41.267.1.7(01-01-2020)
Related Resources
The following table lists the IRM primary sources of guidance on the processing of paper filed forms under the Affordable Care Act program.
IRM
Title
Guidance onIRM 3.10.5
Campus Mail and Work Control - Batch/Block Tracking System (BBTS)
utilizing BBTS to drop unit production cards for daily incoming receipts and production
IRM 3.10.72
Campus Mail and Work Control - Receiving, Extracting, and Sorting
receiving, extracting, sorting, and routing mail within the Submission Processing campuses
IRM 3.10.8
Campus Mail and Work Control - Information Returns Processing
fine sorting, correspondence routing and disposition for Information Returns Program
IRM 3.13.62
Campus Document Services, Media Transport and Control
shipping of SCRIPS requests
IRM 3.41.274
OCR Scanning Operations, General Instructions for Processing via SCRIPS
workstation functions, workstation keyboard, windows environment and general instruction for entering data from tax returns and related data through SCRIPS
IRM 3.41.275
OCR Scanning Operations, Scanner Operations on SCRIPS
scanning returns on the SCRIPS scanner
IRM 10.5.1
Privacy and Information Protection - Privacy Policy
shipping of SCRIPS requests
Document 12990
Records and Information Management Records Control Schedules
time frame to destroy paper sample after conversion to electronic data records
Document 13056
Employee Toolkit: Shopping for Personally Identifiable Information (PII)
shipping of image SCRIPS requests
Document 13144
Proper PII Shipping Procedures
shipping of SCRIPS image requests
Training 2335-series
Instructor’s Corner for Submission Processing - SCRIPS
course material for SCRIPS entry, located at https://program.ds.irsnet.gov/sites/WILESPInstCrnr/SCRIPS/Forms/AllItems.aspx
IRMs present on Servicewide Electronic Research Program (SERP) at the following site: http://serp.enterprise.irs.gov/homepage.html. Specific instructional links available on the IMF Data Conversion Research Portal located at http://serp.enterprise.irs.gov/databases/portals/sp/imf/data-conversion/data-conversion.html.
IRM 3.13.62, Campus Document Services, Media Transport and Control, or IRM 10.5.1, Privacy and Information Protection - Privacy Policy, provides information on shipping Personally Identifiable Information (PII). This document is located at: http://publish.no.irs.gov/mailtran/pii.html, titled Postal and Transport Policy.
3.41.267.2(01-01-2018)
Introduction
This IRM section describes certain tasks necessary in the processing of Affordable Care Act information returns processing (ACA-IRP) filed on paper with the Service Center Recognition/Image Processing System (SCRIPS).
Submit IRM deviations in writing following instructions from IRM 1.11.2.2, Internal Management Documents System - Internal Revenue Manual (IRM) Process, IRM Standards, and elevated through proper channels for executive approval.
The IRS adopted the Taxpayer Bill of Rights in June 2014. Become familiar with taxpayer rights. See IRC 7803(a)(3), and the following site for more information about the Taxpayer Bill of Rights: https://www.irs.gov/taxpayer-bill-of-rights.
3.41.267.2.1(01-01-2021)
Source Documents
The instructions in this section apply only to the form types listed below for tax years 2017 through 2020:
Affordable Care Act Information Returns Processing (ACA-IRP)
Form, Title
Form CharacteristicsForm 1094-B, Transmittal of Health Coverage Information Returns
transmitting one or more Form 1095-B, Health Coverage
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
transmitting one or more Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
Stand-alone Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns (SA1094C)
must have an entry in both corrected box (checked) and Part I, Line 19 box (checked)
Form 1095-B, Health Coverage
transmitted by Form 1094-B, Transmittal of Health Coverage Information Returns
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
transmitted by Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
3.41.267.2.2(01-01-2018)
Program Codes
Program number 44320 is used for the processing functions of Affordable Care Act information returns as instructed in this IRM.
Limit output files to approximately 200,000 data records of each form type ("B" and "C" ) to accommodate the receiving systems limitations.
Example:
A valid output file consists of no more than 200,000 data records of form type "B" and 200,000 data records of form type "C" .
3.41.267.2.3(01-01-2018)
How to Use This Internal Revenue Manual (IRM)
Keystroke Combinations:
Carets enclose keystroke combinations (e.g., ).
A hyphen separates multiple keystroke combinations (e.g., -M). This means hold down the key while pressing the "M" key.
Terms and Acronyms - Exhibit 3.41.267-1, Terms/Definitions/Acronyms, lists terms and the definitions of terms related directly and indirectly to ACA-IRP SCRIPS processing.
QUICK START - Each function (Original Entry Image (OE-Image), Data Validation Image (DV-Image)) begins with QUICK START instructions intended to speed access to a unit-of-work (UW). For detailed data entry and validation instructions found in the following narrative, see IRM 3.41.267.9, General Correction Procedures, and the tables and transcription sheet exhibits in the back of this IRM. More general instructions appear in IRM 3.41.274, OCR Scanning Operations, General Instructions for Processing via SCRIPS.
Reminder:
Whenever IRM 3.41.274, OCR Scanning Operations, General Instructions for Processing via SCRIPS, and this IRM conflict, this IRM takes precedence.
Tables
Table Location
Table
Table Entries and UseExhibit 3.41.267-1
Terms/Acronyms/Definitions
provides the corresponding definitions for the provided listing of terms and abbreviations used throughout section 267 of chapter 41.
IRM 3.41.267.1.7
Related Resources
list related resources to use in conjunction with the instruction given
IRM 3.41.267.2.1 (1)
Source Documents
Form list and form characteristics
list each form name and title and states the characteristics of each form type
IRM 3.41.267.5 (3)
Workstation Operations
Specific Key Functionality
list specific keyboard keys and key combinations with the functionality of each listed
Exhibit 3.41.267-2
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State
lists ZIP code ranges sorted by the state
Exhibit 3.41.267-3
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code
lists states sorted by the ZIP code range
Exhibit 3.41.267-4
Zone Improvement Plan (ZIP) Code, City, and State Exceptions
lists exceptions to the ZIP code ranges
Exhibit 3.41.267-5
Alphabetical Listing of Major Cities with Major City Codes and Zone Improvement Plan (ZIP) Codes
lists major city codes for use with address entry
Exhibit 3.41.267-6
Affordable Care Act Information Return Transcription Sheets
lists screen prompt and instruction by form page for use in the OE and DV functions
Exhibit 3.41.267-7
Valid Characters
list valid characters and describes the characters allowed in fields present on the transcription sheets
Transcription sheets:
Exhibit 3.41.267-6, Affordable Care Information Return Transcription Sheets is transcription sheets for use in the OE and DV functions.
Separate sheets for each form type and page number with screen prompts, description and instruction of each individual data field present on the documents is available.
These sheets provide most of the information needed to process ACA-IRP documents on SCRIPS.
3.41.267.3(06-27-2017)
Affordable Care Act Information Return Processing Document Preparation
Use IRM 3.41.275, OCR Scanning Operations, Scanner Operations on SCRIPS, for instruction on scanning forms into the SCRIPS system.
Perform perfection by placing the UW in the proper succession (order) to make it scannable.
Example:
A Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, has a blank page 2 and a completed page 2 followed by a page 3. Cover the entire blank page 2 or copy page 1, to make the work scannable for SCRIPS system.
If condition exists prohibiting scanning of a processable UW perform OE from paper process on the UW.
Note:
Form 1094 (series) return must still undergo image only process for the retention copy.
3.41.267.3.1(01-01-2021)
Coding of Late-Filed Submissions
Late filed Form 1094-B, Transmittal of Health Coverage Information Returns, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, submissions received from the IRP sort function with an IRS Received Date stamp require the Delinquent Return Date (IRS received date) and Delinquent Return Indicator information processed.
Delinquent Return Indicator - Located in the "For Official Use Only" area (first box). Do not enter a date if indicator is ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡.
Delinquent Return Indicator
Definition of Indicator
Delinquent Return Date≡ ≡ ≡
Assessed Return
No date entry
≡ ≡ ≡ ≡
Collection secured
No date entry
≡ ≡ ≡
Examination secured
No date entry
≡ ≡ ≡
Suppress notice indicator
No date entry
≡ ≡ ≡
Prepared by Civil Penalty Unit
No date entry
≡ ≡ ≡ ≡
Penalty assessment is automatic
Date entry
Return date
for tax year 2020 ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
for tax year 2019 ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
for tax year 2018 ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
for tax year 2017 ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
blank
Timely filed - no date
No date entry
A Delinquent Return Date, (boxes 2 through 7) is not present on the transmittal (Form 1094 (series) return) AND delinquent return code ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ is not present, AND it has a valid IRS received date stamp, a delinquent return indicator of "≡ ≡ ≡" and a valid received date entered in the 2nd, 3rd, 4th, 5th, 6th and 7th "For Official Use Only" boxes. Enter the date in the MMDDYY format from the boxes or the received date stamp. If there is an "≡ ≡ ≡" entered in the field and no delinquent return date or an invalid delinquent return date is present remove the "≡ ≡" .
3.41.267.3.2(01-01-2021)
Scanner
See scanner operator instruction in IRM 3.41.275, OCR Scanning Operations, Scanner Operations on SCRIPS, for complete scanner operating instructions.
Select manual feed process from the transport console "IRP-ACA" menu to scan hand drop ACA-IRP.
Note:
The system assumes the first page is a Form 1094 (series) returns.
Scan submissions (Form 1094 (series) and all associated Form 1095 (series)) again one submission at a time.
Note:
The scanner does not reject any pages except mechanical rejects.
Press the key to denote the end of the submission and prompts "Start New Batch, or Q to Quit".
Do not scan batches or boxes of work having many missing or invalid Form IDs on the submissions but return to IRP Sort function for correction. See IRM 3.41.267.4.1, Unprocessable Unit-of-Work Conditions, for instruction on defining invalid Form ID.
3.41.267.3.2.1(06-27-2017)
Scanner Rejects
The scanner prints the reject code "M" (Mixed Document Type) or "X" to the left of the Document Locator Number (DLN) area on any form or page rejection.
A mixed document type submission received from the scanning function is one of the form types listed in IRM 3.41.267.2.1 (1), Source Documents.
Only "non-conforming" , mixed, invalid document types, or pages within the submission reject.
3.41.267.3.3(01-01-2016)
Correspondence on Processable Returns
No entry is "valid" for use with this program.
Remove any entry present in the screen input if noticed.
3.41.267.3.4(01-01-2019)
Post Document Preparation (Doc Prep) Required
Pull and return to the IRP sort function daily any documents and UWs SCRIPS cannot resolve listed on the IRP ACA Pull Document/Submission Report. See IRM 3.41.267.12.9, Pull Unit of Work (Submission) Report for information on the report.
Send Integrated Data Retrieval System (IDRS) image requests daily by secure e-mail to the Unit manager of the requesting unit. Use IDRS Unit & USR Database located at the following link to retrieve the e-mail addresses: https://iors.web.irs.gov/HomeIUUD.aspx. Use "ESTAB Request" as the subject of the secure e-mail.
Note:
An IDRS List Report is available under General Reports in the backend of the system for use on volumes. Local level can complete more actions or negotiate alternate distribution with requesting organizations barring excessive staff hour usage.
3.41.267.4(01-01-2016)
Unprocessable Unit-of- Work
Return to the IRP sort function all unprocessable documents requiring correspondence. The IRP sort function corresponds with the filer concerning their submission and ask the filer to refile processable documents.
3.41.267.4.1(01-01-2021)
Unprocessable Unit-of-Work Conditions
The following conditions make a "return" unprocessable:
You cannot determine what the taxpayer data is (foreign language, completely illegible).
You cannot determine the type of return.
You cannot determine the tax year of the return.
Invalid tax year on the 1094 series.
Example:
SCRIPS does not process tax years equal to the processing year minus five or more.
You cannot determine the tax year of the submission.
Example:
The tax year on the transmittal and the tax year on all details do not match.
When the name of the filer/employer on the transmittal document (Form 1094 (series)) has one or more of the first four characters present illegible, is entirely illegible, or missing and is not available from the first detail record.
Exception:
For Form 1094-B, Transmittal of Health Coverage Information Returns, the filer is not available from the first detail record or any of the detail documents.
The filer altered box titles.
The submission did not have a transmittal (corresponding Form 1094 series return).
Form ID is invalid, missing, in the wrong font, or in the wrong location on the submission or part of the submission.
Units of work (UW) where 50 percent or more of the TINs (social security numbers (SSNs)) show only the last four-digits of the SSNs (appear redacted).
Example:
If the SSN or a part of the SSN present is masked, hidden, represented by asterisk or, incomplete in any way consider it redacted.
When the filer or employer Taxpayer Identification Number/Employer Identification Number (EIN) on the transmittal has an illegible character or is missing and not available on the first detail.
Exception:
For Form 1094-B, Transmittal of Health Coverage Information Returns, the filer is not available from the first detail record or any of the detail documents.
When the EIN on the transmittal is equal to a repeating number or sequential numbers.
Example:
A repeating EIN is 11-1111111, 22-2222222, etc., and a sequential EIN is 12-3456789.
The submission is a Form 1094-B, Transmittal of Health Coverage Information Returns, with no corresponding Form 1095-B, Health Coverage, records.
The employer EIN on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, does not match the employer listed on Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, transmitted and is noticed.
Caution:
This does not apply to the "B" series.
The submission is a Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, with no corresponding Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, records "and" the corrected box "and" line 19 both "do not have a marked".
3.41.267.4.2(01-29-2019)
Unprocessable Unit-of-Work Disposition
Pull unprocessable units-of-work (UW) daily and returned to the IRP sort unit for taxpayer correspondence or disposition.
A report titled, IRP ACA Pull Document/Submission Report, displays unprocessable UWs. Pull these daily and returned to the IRP sort unit. See characteristics of the report in IRM 3.41.267.12.8, Pull Unit of Work (Submission) Report.
Exception:
PULL IMAGE ONLY and PULL IMAGE ONLY - NO DLN require resolution in SCRIPS. At this time Image Only is not used.
Tag each condition prior to forwarding to IRP Sort with the reason code given on the pull report for a specific unit-of-work to allow the determination of correspondence sent for these unprocessable documents.
Example:
The site can choose to create a routing sheet and include pull document reason codes, circle the code for each unit-of-work and attach it when returning the unprocessable documents to IRP Sort unit.
3.41.267.5(01-01-2020)
Workstation Operations
Refer to the IRM 3.41.274, OCR Scanning Operations, General Instructions for Processing via SCRIPS, for a description of these and other items:
Keyboard Layout
Login/Logoff
Operator Statistics
Post-to-Close
Interrupt/Resume
Suspend/Resume
Status Line
Window Prompts
Key Functions
Whenever IRM 3.41.274, OCR Scanning Operations, General Instructions for Processing via SCRIPS, and this IRM conflict, this IRM takes precedence.
Each key or key combination description is the functionality while inside the SCRIPS system and does not apply to keyboard functionality on other programs. Below listed some function key descriptions.
Key
Description
Allows you to move the entry field to a different place relative to the area on the scanned image.
Allows you to go back and review previous documents or previous pages in the unit-of-work.
Places the cursor in Overstrike Mode. The keyboard is normally in Overstrike Mode; however, takes the keyboard out of Overstrike Mode.
--
--
Deletes a unit-of-work.
-
and arrow keys (←→↑↓arrows)
Allows you to move the image strip when it is not lined up. Holds the position for the current image.
-
Copies the data from the same field on the previous document.
ACA IRP: Allows you to move between page 1, page 2 and or page 3(s) of Form 1094-C, Form 1095-B and Form 1095-C.
ACA IRP: Allows you to move between page 1, page 2 and or page 3(s) of Form 1094-C, Form 1095-B and Form 1095-C.
Shift-Print Screen
Prints the current screen on the monitor.
Caution:
Release the Print Screen button first and then the shift key. The printing action takes place upon the release of the Print Screen keystroke.
-M
Enlarges the size of the scanned image appearing above the entry field.
-L
Reduces the size of the scanned image appearing above the entry field.
3.41.267.6(01-01-2016)
Forms Identification (FI) Function
Non-conforming form is when the scanner does not recognize all documents or all pages of the document. These include photocopies of official documents, official forms but for some reason do not meet the official specifications for measurement, homemade documents of varying formats or documents without or with invalid form identification numbers in the upper right-hand corner of the page. The FI function allows the manager/work leader to identify the form (or the page of the form) to avoid rework at the scanner. The FI screen has an image and an entry template on the right. The entry template permits the operator to select what form type the image is, or to delete a single image or an entire submission from further processing. The menus shown on the screen depend on how your supervisor profiled you.
Example:
This option is grayed on the Workstation Main Menu if it is not in your profile.
3.41.267.6.1(01-01-2018)
Forms Identification (FI) QUICK START
From the Workstation Main Menu, select the numeric code for Original Entry (OE).
From the Original Entry (OE) Selection Menu, select the numeric code for Form Identification (FI) Selection Menu.
From the Form Identification (FI) Selection Menu, select the numeric code for the type of FI needed.
The first group of images, from a Unit-of-Work (UW) requiring identification, opens.
If an incorrect option is selected from the Form Identification Selection Menu, press the -P key combination to set post-to-close and press to suspend, before entering any data, to return to the Form Identification Selection Menu.
Note:
Notify your supervisor.
Press the -P key combination to end FI after completing the current UW.
The system returns you to the Form Identification Selection Menu when the last image identification in the UW is completed.
3.41.267.6.2(01-01-2021)
Form Identification (FI) Processing
The system assigns a six-digit sequence number instead of a document locator number (DLN) to documents it cannot identify. This number assists in locating the UW when researching documents. Once the form type/page is identified, the system assigns a DLN to the document.
Identify the image, make the proper number or letter selection from the template in the form identification menu selection. The tables below appear on the SCRIPS workstation directly below each other.
Form 1094 Series
Menu Option
Form (Form ID)
Menu Option
Form (Form ID)A
1094-B pg 1 (11016)
B
1094-C pg 1 (120118)
C
1094-C pg 2 (120218)
D
1094-C pg 3 (120316)
Form 1095 Series
Menu Option
Form (Form ID)
Menu Option
Form (Form ID)1
1095-B pg 1 (560118)
5
1095-C pg 1 (600120)
2
1095-B pg 1 (560116)
6
1095-C pg 1 (600118)
7
1095-C pg 1 (600117)
3
1095-B pg 3 (560318)
4
1095-B pg 3 (560317)
8
1095-C pg 3 (600320)
9
1095-C pg 3 (600318)
10
1095-C pg 3 (600317)
X
Remove
Press the key to complete a selection.
Press to suspend the document for the person working suspense to research when you cannot identify the image. If the image is unprocessable, press "X" to remove the document from further processing.
Suspend the document for the supervisor if the image is a form type other than ACA IRP (such as Form 1040 or Form 941) by pressing . The person working suspense pulls the documents for proper routing before pressing "X" to remove the document from further processing.
If multiple form types exist in a submission, research is needed to determine if the submission requires deleting. Deleting the entire submission is sometimes more efficient, than removing many single documents. Delete submissions by pressing the -- or -- key combination.
Press the -P key combination to set post-to-close to end the session. The system returns you to the Original Entry (OE) Selection Menu when you complete the last image in the UW.
3.41.267.7(01-01-2016)
Original Entry (OE) Function
The OE function is used to manually key enter data from both scanned images and from paper documents. The menus shown on the screen depends on how your supervisor profiled you.
Example:
This option is grayed on the Workstation Main Menu if it is not in your profile.
3.41.267.7.1(01-01-2018)
Original Entry (OE) Image QUICK START
From the Workstation Main Menu, select Original Entry (OE).
From the Original Entry (OE) Selection Menu, select OE Image Selection Menu.
From the OE Image Selection Menu, select ACA-IRP OE Image Selection Menu.
From the ACA-IRP OE Image Selection Menu, select one of the following:
1 - All ACA-IRP OE Image
2 - 1094-B OE Image
3 - 1094-C OE Image
After the selection is entered press as prompted or press -X to exit to previous menu.
The first individual document in a UW requiring OE opens. See Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets.
The scanned image of the document displays on the left side of the workstation screen.
The right side of the workstation screen is where the data is input in the specific field window.
If an incorrect option is selected, press the -P key combination and then suspend this UW. Notify your supervisor.
If the last data entered is not the last field of the page and there is no other data present on the page, press key to release a document and display the next template.
Press the -P key combination (post-to-close) to end OE from Image.
The system returns you to the Original Entry (OE) Selection Menu when you complete the last document in the current UW.
3.41.267.7.2(01-01-2017)
Original Entry (OE) Image Processing
The Status Line at the bottom of the screen displays the following information:
The program field is 44320 for ACA-IRP documents.
The DLN field is the DLN of the document displayed.
The document field is the relative count of the document.
Example:
If it is the first document in a unit-of-work with 250 documents, the document field shows a count of 1 of 250.
The Pg field is the relative count of the page of the document.
Example:
If it is Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, page 1, the Pg field shows 1 of 2 or 1 of 3 depending on the length of the return filed; Form 1094-C page 2 shows as 2 of 2 or 2 of 3 depending on the length of the return filed.
The Status Line is "IN" when the insert mode is on and "Nu" when the numeric mode is on.
In OE from image, you manually enter information into the template using a scanned image of the return as a source.
3.41.267.7.3(01-01-2018)
Original Entry (OE) From Paper Quick Start
From the Workstation Main Menu, select Original Entry (OE).
From the Original Entry (OE) Selection Menu, select OE Paper Selection Menu.
From the OE Paper Selection Menu, select IRP ACA OE Paper Selection Menu.
From the IRP ACA OE Paper Selection Menu, select the form type:
1 - 1094-B OE Paper
2 - 1094-C OE Paper
If the wrong program is selected and the first page of the first document is not complete, press the key to cancel the entry. You return to the IRP ACA OE Paper Selection Menu.
3.41.267.7.4(01-01-2019)
Original Entry (OE) From Paper Processing
In OE from Paper, the workstation operators manually enter information into the system and eliminate all transport processing. The operators need the paper IRP ACA units-of-work to perform OE from paper. SCRIPS assigns a DLN for each document entered from paper but does not print them on the documents. As each new IRP ACA document is processed, the system displays the DLN of the document in the DLN field of the status Line at the bottom right side of the screen.
After selecting the form type from the IRP ACA OE Paper Selection Menu, your first prompt is for the form year, followed by the system reminder window "Enter amounts as DOLLARS ONLY" .
A blank Form 1094-X template is displayed for the first document in the block with the Sequence Number field displayed for entry. The first document must begin with sequence number "00" .
The Status Line at the bottom of the monitor screen displays the following information:
The Program field shows 44320 for IRP ACA documents.
The DLN field shows the DLN of the current document.
The SUB field shows the relative count of submission work.
The Status Line shows "IN" when the insert mode is on and "Nu" when the numeric mode is on.
Write the DLN assigned by the system in the upper right-hand corner of the paper document (either the Form 1094-X or Form 1095-X as determined at the site location). The system assigned DLN is shown in the DLN field of the Status Line.
Reminder:
Writing the DLN for the Form 1094-X is necessary so subsequent operators can retrieve the unit-of-work (UW).
After entering Pg 1 (or 2), your next prompt is "Is a page 2 (or 3) present?" . Never enter a page without significant taxpayer data, not considered processable, or is a page not data captured such as the instruction pages or duplicate taxpayer forms.
Exception:
Form 1094-B, Transmittal of Health Coverage Information Returns, has a Pg 1 ONLY, therefore the system moves straight into a Form 1095-B, Health Coverage, template.
If "Yes" , a page 2 (or 3) template is presented.
If "No" , you see a prompt "Is next document 1095-X?" .
Response Choice
If
Action
Then"Yes"
A 1095-X is presented asking for a sequence number.
Note:
When entering a 1095-X, the different DLN in the Status Line is like a 1099 detail document in regular IRP versus the 1096 DLN
"No"
Presentation is the next sequence number prompt for the same document type
After entering all documents press the and keys to end OE from paper or press -P (Post-to-Close) while entering, but before releasing the last document in the UW. The system returns you to the IRP ACA OE paper Selection Menu.
3.41.267.7.5(01-01-2018)
Releasing a Unit-of-Work in Original Entry (OE)
For OE Image, when you release the last document in a unit-of-work, the UW is released:
If -P is pressed before releasing the UW, the OE Selection Menu opens.
If -P is not pressed, another UW opens.
3.41.267.7.6(01-01-2018)
Selecting a Specific Unit-of-Work in Original Entry (OE)
A specific ACA-IRP unit-of-work is selected for OE by following these steps:
Select the numeric code for OE from the Workstation Main Menu. The Workstation Main Menu closes, and the OE Selection Menu opens. The menus shown on the screen depend on how the operator is profiled by supervisor.
Enter the numeric code for OE Select Block from the OE Selection Menu. The OE Selection Menu closes, and the Open Block/Unit-of-Work window opens.
Enter the 14-digit DLN from the Form 1094 (series) return from the Open Block/UW window.
Press the key. The open Block/UW window closes and the selected UW opens. If the block is not available, an error message is displayed indicating the block is not available.
Example:
A message is displayed if you previously worked on the block, or if another operator is currently working on the Block/UW.
Enter data using IRM 3.41.267.9, General Correction Procedures, and Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets, and other instruction in this IRM on the open designated Form 1094 (series) document.
Press the -P key combination and then suspend the unit-of-work if an incorrect UW is selected for the Block/UW menu then notify your supervisor.
3.41.267.8(01-01-2018)
Data Validation (DV) Function
The DV function is used to manually correct data from scanned images. The menus shown on the screen depends on how your supervisor profiled you.
Example:
This option is grayed on the Workstation Main Menu if it is not in your profile.
The Status Line at the bottom of the screen displays the following information:
The DLN field shows the DLN of the document displayed.
The SUB field shows the relative count of the document.
Example:
If it is the first document in a UW with 80 documents, the SUB field shows a count of 1 of 80.
The Pg field shows the relative count of the page of the document.
Example:
If it is Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, page 1, the Pg field shows 1 of 3, page 3 shows as 3 of 3.
The Status Line shows "Au" when the automatic mode is on, "IN" when the insert mode is on, and "Nu" when the numeric mode is on.
Note:
Auto Indicator turns the Auto Mode on and off. When Auto is on, the cursor automatically moves from the current field to the next field requiring perfection. When Auto is off, the cursor manually moves through every field using the cursor movement keys. A Select Block or Suspended Block in DV requires the operator to restore the Auto On mode using --.
3.41.267.8.1(01-01-2021)
Data Validation (DV) From Image QUICK START
From the Workstation Main Menu, select the numeric code for Data Validation (DV).
From the Data Validation (DV) Selection Menu, select the numeric code for DV Selection Menu.
DV Selection Menu
IRP 1096 Image Only
IRP ACA Image Only
Resume Suspended Blocks
DV Select Block
IRP ACA DV2 Select Block
From the DV Image Selection Menu, select the numeric code for DV Selection Menu.
1 - All IRP ACA DV
2 - 1094-B DV
3 - 1094-C DV
4 - All Scanned IRP ACA DV2
The first UW opens, and the cursor stops at the first highlighted field when the AUTO is on. Use the exhibits in this IRM and the general correction procedures to make necessary corrections.
If an incorrect option is selected from the DV Selection Menu before entering any data, press -P, press to suspend and return to the DV Selection Menu. Notify supervisor.
After entering the last field on document, if Auto is off, press the key to release the document and display the next template.
Press the -P key combination to stop a new block form appearing once the current UW is completed.
The system returns you to the Data Validation (DV) Selection Menu when you release the last document.
3.41.267.8.2(01-01-2021)
Selecting a Specific Unit-of-Work in Data Validation (DV)
A specific UW of ACA-IRP documents, is selected for DV by following these steps:
From the Workstation Main Menu, select the numeric code for DV. The Workstation Main Menu closes, and the DV Selection menu opens. The menus shown on the screen depend on how your supervisor profiled you.
Example:
This option does not display on the menu if it is not in your profile.
From the Data Validation (DV) Selection Menu, enter the numeric code for DV Select Block. The Data Validation (DV) Selection Menu closes, and the Open Block/Unit-of-Work window opens.
Enter the 14-digit DLN from Form 1094 (series) document.
Press the key. The Open Block/UW window closes and the selected UW opens.
The first document needing correction opens.
Enter data using Exhibit 3.41.267-6, Affordable Care Act Information Return Transcription Sheets, and other exhibits, as needed, in this IRM.
A suspended UW in DV requires the operator to restore the "Auto ON" mode.
Reminder:
If after entering the DLN, the screen goes white for a second and then returns to the menu, the block is technically worked. The system ran through all the system checks resulting in no errors.
If an incorrect UW is selected from the Block/Unit-of-Work menu, press the -P key combination and suspend the UW. Notify your supervisor.
Use menus option IRP ACA DV2 Select Block to correct blocks exceeding threshold checks previously entered.
3.41.267.9(01-01-2021)
General Correction Procedures
Use these procedures as a guide during the Original Entry (OE) and Data Validation (DV) functions. Not all items apply to specific situations in either function. You may have to correct a field not highlighted because of a correction made to a highlighted field. Sight verify any field with any incorrect characters. If the system stops on a field, sight verify and correct all incorrect items present in the field.
If you reach the maximum field length while entering data, the cursor, in most cases, automatically moves to the next field. Remove or correct incorrect characters inadvertently entered in the next field.
Any checkbox present on any form type requires sight verification if the system reads the box as marked.
The -4 (Override key) is not enabled for field character type, tax year, or invalid date (MMDDYYYY).
Example:
Invalid dates: 01321980, 13011980, 00011980, 01020080 or a date before 01011901.
Date of Birth (DoB) fields is entered if MM, DD, YYYY, or YY is present and the century (or taxpayer intent) is determined. An entry missing any of the combination "is not" a DoB. Do not enter any data in the field if you cannot determine all three things.
Error Messages—Messages found in the Prompt Area with information giving helpful hints to correct the error. Most error messages consist of two lines with the first line displaying the error message and the second information to help resolve the error condition.
An asterisk (*) at the upper right-hand corner of the normal proper placement of the numerous check boxes present on the return represent the skip key stop points.
Caution:
Taxpayer generated forms may not have the checkbox placement in the correct location. Do not mistake the skip box asterisk for taxpayer entries during OE or DV operations.
While working in OE Image or DV Image, if you cannot determine the data for any field (except the Street Address, City fields) from the image because it is illegible or the image is incomplete, suspend the UW and pull the paper document for verification.
While working in OE Image or DV Image, do not enter data marked out or crossed through by the filer. Do enter data written in or placed on the document in different font.
Press the key to view the entity information from a Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, while the transmitted form is displayed for reference. It also displays the entity information from the transmitted form while a Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, is displayed.
In certain situations, the scanner may read a name or address or even a city without spaces or spread over the name line or address fields. If the system read the name and address correctly, leave as is.
Note:
If the scanner reads a line correctly but placed the information in an incorrect field, move the information as scanned to the correct entry field using up and down arrows. Moving an address to the correct field does not require updates to standard abbreviations.
The - combination key function provides the operator the ability to access the last edited field or the last flagged field of the previous document.
Taxpayer Identification Number (TIN) fields (Social Security Number (SSN) or Employer Identification Number (EIN)) presented as 1-xxx-xx-xxxx-0 or 1-xx-xxxxxxx-0, or any variation thereof, is entered as xxxxxxxxx, omitting the leading and ending numeric.
If detail documents (Form 1095 series) presented consecutively have the same responsible party or employee and the same covered individuals duplicated, enter one document and VOID the duplicate(s).
For more information on function keys refer to the table in IRM 3.41.267.5(3), Workstation Operations, or IRM 3.41.274, OCR Scanning Operations, General Instructions for Processing via SCRIPS, Exhibit 3.41.274-1, Function Key Use and Description by Form Type, and Exhibit 3.41.274-2, Summary of Function Keys by Form Type.
Cross field validations occur on certain conditions and require data entry clerk sight validation and verification. Follow the screen prompts to allow systemic determination of the disposition of the UW. See the table below for these conditions.
Form Number
Field
Comparison Field(s)
Valid Condition
Invalid Condition(s)
Requiring Sight Verification1094-C
Line 19
Part II
Part III
Part IV
L19 is blank PII, PIII and PIV is blank.
L19 is marked PII, PIII and PIV each has some or all data.
L19 is blank PII, PIII and PIV each or individually partially or fully populated.
L19 is marked PII, PIII and PIV is blank.
>sight verify
1095-B
and
1095-C Covered Individuals:
SSN
DoB
SSN is present and no DoB is present
SSN is not present and a valid DoB is present
No SSN is present no DoB is present and no name is present
Partial SSN is present and no DoB is present
SSN is not present and an invalid DoB is present
No SSN is present no DoB is present and no name is present
>sight verify
1095-B
and
1095-C
All 12 months
one or more 'month' marked
All 12 months box is checked, and Jan through Dec boxes have no checks
All 12 months box is checked and one or more of Jan through Dec boxes have a check
>sight verify
1095-B
Page 3
SSN
and/or DoB
Page 1
Line 2
and/or Line 3
Entries match
data capture continues
Entry mismatch
Page 3 is dropped
>sight verify
1095-C
Tax Year 2019, 2018, and 2017
Page 3
Employee SSN
Page 1
Line 2
Entries match
data capture continues
Entry mismatch
Page 3 is dropped
>sight verify
The system performs threshold validations and places documents in DV2 when 50 percent or more of the SSNs and/or DOBs in the UW appear missing or invalid. This condition requires sight validation and verification. Turn the auto off and arrow back to column A under covered individuals to correct erroneously entered name field data. Follow the screen prompts to allow systemic determination of the disposition of the UW. See threshold reason codes at IRM 3.41.267.12.9 (4).
Note:
A pop-up notification appears at the beginning of the block, "This submission does not meet threshold validation criteria: Invalid SSN and DOB. It deletes after DV unless the field data is modified." Press "OK" and proceed with sight verification.
3.41.267.9.1(01-01-2019)
Name and Address Block Reader (NABR)
Name and Address Block Reader is referred to as NABR. NABR is used to improve the accuracy of addresses captured by the scanner from IRP documents. The NABR accomplishes this improvement by comparing the address captured by the scanner with a database of addresses used by the United States Postal Service. SCRIPS uses NABR to run addresses through a Postal Database.
When validating a NABR change, ensure the system read the correct ZIP Code. Correct the data to match the image if the city and state do not match the image and a correct ZIP Code is not present in the data field.
The system prompts an operator to "Please verify" the following conditions:
State is determined by the system from the city present
State is determined from the ZIP Code present
City is updated by the system to a phonetic match
City determined from ZIP
Acceptable city name used
Note:
NABR does not appear in the bottom right-hand corner in the conditions listed above.
3.41.267.9.2(06-25-2019)
Name Entry
Enter the information as shown on the document, in the provided name line or the first, middle initial, and last name/full name except as instructed below:
If the filer has submitted the same name twice on a form, enter it only once.
Space for a period.
Never enter two consecutive spaces.
If during sight verification a correction is made, or if in OE, enter the first name first and last name last.
Space within a true last name where shown.
Omit apostrophe (') if shown in name line. Do not space for an apostrophe.
Omit slash (/) if shown in name line. Space for a slash.
Enter a hyphen (-) where shown. Do not space before or after the hyphen.
Enter numerics present in the name line.
Enter ampersand "&" when present in the Form 1094 series name line or the Form 1095 series last name/full name line.
Data normally entered on Name line 2, such as; doing business as (DBA), in care of (C/O) or %, or also known as (AKA) is entered/placed behind the business name if a correction requires your intervention.
Note:
Do not enter %, DBA or AKA. If scanner reads DBA or TA correctly and no other correction is needed, leave as is.
Omit the designation only such as Trust Agreement (TA), DBA, AKA, Owner, Proprietor when entering data.
Note:
Do not enter DBA or TA. If scanner reads DBA or TA correctly and no other correction is needed, leave as is.
Do not enter the designations or data for: Formerly known as (FKA), formerly DBA or any data after these designations.
Tax year 2018 and later forms have specific areas for first name, middle initial, and last name. Separate the name entered to the first name, middle initial, and last name fields if able to determine the data when the filer does not place the names in the proper fields. If you cannot determine place the entire name present in the last name field.
Do not enter "No Middle Initial" (NMI), "No Middle Name" (NMN), or "No Last Name" .
Always enter suffixes Jr., Sr., or Minor after the last name in the last name field. Omit suffixes such as MD, TP, and SP.
If only a single name appears consider it the last name and enter it in the last name field.
3.41.267.9.3(01-01-2018)
Address Elements
Enter the information exactly as shown on the document except as instructed below or when the NABR has perfected the address. See IRM 3.41.267.9.1, Name and Address Block Reader (NABR):
Do not enter periods in the address field, however, acceptable is punctuation such as slash (/) and hyphen (-). If a period is present between two numbers enter a space for the period.
If an ampersand is present in the street address enter as AND.
If an apostrophe is present omit the apostrophe and do not leave a space for the apostrophe.
If perfecting only part of the address, such as the state or Zone Improvement Plan (ZIP) Code do not go back to the street address to abbreviate or correct characters if the scanner picked up the street address as present on the document.
Exception:
If the name of the street is a direction, the direction is spelled out. Do not abbreviate street names.
Example:
123 North Street is entered as 123 NORTH ST.
If a document has a street address and a PO Box, enter both on the address line with the PO Box or (*) entered first. If the combination is too long, the PO Box takes precedence. Also, use abbreviations as necessary to limit this entry to 35 positions. Enter as much of the street address with abbreviations as possible.
When two street addresses with the same city and ZIP appear, enter the first street address. If two addresses appear, including a PO Box and an address, with different city and ZIP, enter the first in the address, city, state and ZIP fields.
Omit "No", "No.", "Num", "#" symbol and "Number" if it appears as a prefix to a house, apartment, Route, or PO Box number.
If North, South, East or West is shown as part of the city name, use the standard abbreviation (such as N=North, S=South, etc.). NEVER use a Major City Code and the standard abbreviation together.
Example:
West Miami enter as W MIAMI, not W MF.
If the city has numerics, enter as alphas.
Example:
29 Palms enter as TWENTY NINE PALMS.
Abbreviate only the last designation present if multiple street designations appear.
Example:
1234 Circle Road Drive is entered as: 1234 CIRCLE ROAD DR
If correcting or transcribing an address field add ST, ND, RD or TH to a numbered street when there is a street designation such as Road or Street.
Note:
102 S. 38 Road is transcribed as 102 S 38TH RD
If the street address is not determined or is blank, enter "Z" in the Address field. If the city is not determined or is blank, enter "ZZZ" in the City field and leave the State and ZIP Code fields blank.
Enter standard abbreviations for states and territories as shown in Exhibit 3.41.267-2, States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State, and Exhibit 3.41.267-3, States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code.
If there is no state, but a ZIP Code is present, enter the ZIP Code as shown and press . This generates the state code for this ZIP Code in the prompt area. Follow the screen prompt to accept this code or to enter a different code.
If there is no ZIP Code (or the ZIP Code is less than or more than five-digits) but a state is present, press the key in the ZIP Code field. The system generates the default ZIP Code for this state.
Note:
DO NOT generate the default ZIP Code without first entering the ZIP Code "if" present on the form.
If the system finds the ZIP Code entered and present on the form does not match the state code present, the system asks "Is this a foreign address?" . If the answer is "Yes" the system continues by presenting fields for a foreign address entry, Province (17 characters), Foreign postal code (35 characters). If the answer is "No" the system corrects the ZIP Code upon pressing .
Note:
DO NOT generate the default ZIP Code without first entering the ZIP Code present on the form.
Enter foreign street addresses in the street address field, foreign city in the city field, foreign province in the Province field, and Country and foreign postal code in the Foreign postal code field. Use abbreviations as necessary to limit this entry to 35 positions.
Transcribe Army Post Office (APO), Diplomatic Post Office (DPO) and Fleet Post Office (FPO) addresses with the proper two-character state code followed by the corresponding unique five-digit ZIP Code.
When an APO, DPO or FPO is used, do not enter any other data in the city field.
If the ZIP Code is out of range on APO, DPO or FPO addresses, enter 34001 for Miami, 09001 for New York and 96201 for San Francisco or Seattle.
When APO, DPO or FPO is put in the city field, the state code field must correspond with the tables below.
Valid Zone Improvement Plan (ZIP) Code for APO, DPO and FPO
State Code
ZIP Code Range
Geographic LocationAA
340
Americas
AE
090-098
Europe
AP
962-966
Pacific
Example:
EXAMPLE:
ENTER AS:APO New York, NY 091XX
APO AE 091XX
FPO San Francisco, CA 962XX
FPO AP 962XX
3.41.267.9.4(02-19-2016)
Transmittal Taxpayer Identification Number (TIN)
Each transmittal Form 1094 (series) return must have a complete nine-digit (numeric) employer identification number (EIN) present as a processable unit-of-work.
If the EIN is a single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 then the submission is considered unprocessable.
If no employer identification number (EIN) is present and a social security number format is present suspend the UW. The format for EIN is NN-NNNNNNN and the format for SSN is NNN-NN-NNNN.
If the TIN/EIN is missing, illegible, or has more than or less than nine-digits on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, and it is found on the first detail document or determined enter the EIN from the first detail document (Line 8) in the field.
Reminder:
You cannot secure the filers EIN for Form 1094-B, Transmittal of Health Coverage Information Returns, from the details Form 1095-B, Health Coverage
If the complete EIN for a transmittal is not found on the return submission delete the UW by placing nine zeros (000000000) in the EIN field.
3.41.267.9.5(04-23-2018)
Money Amount Fields
Money fields consist of dollars only.
Enter money amounts as follows:
If a dollar amount is present and no cents, enter dollar amount.
If a dollars and cents amount is present, enter the dollars only.
Note:
Do not round the dollars up or down based on cents if present.
If a dollar amount is present and it is followed by a line, dash or hyphen, enter the dollar amount.
If a dollar amount is present and the cents is lined through, enter dollar amount.
If a dollar amount of 0 or 00 is present enter a single 0.
If money amount is a negative zero (e.g., -00, -0.00. -00.00, etc.), remove it. Press to clear the field, and then press the space bar then .
Do not enter negative amounts (identified with a minus (-) before the amount or the amount is within brackets).
If two or more money amounts appear on the same line, press to clear the field and then enter the first dollar amount present.
If the money amount is illegible, suspend the UW as "Poor Quality Image" (; press "S" ; select "Poor Quality Image" ).
If after suspending for "Poor Quality Image" you still cannot determine the correct money amount from the physical document, press to clear the field and then press the space bar then .
If a code or other non-monetary entry is present in a monetary field press to clear the field then press the space bar followed by .
3.41.267.9.6(01-01-2017)
Deleting a Unit-of-Work or Submission
To delete a filer's entire submission (or unit-of-work, or transmittal), enter nine zeroes in the EIN (Line 2) or "00" in the tax year of the Form 1094 (series) return.
Pull and send the deleted Form 1094 (series) and all the associated detail documents back to the IRP sort function. Deleting a submission is usually a procedure used by a manager or work leader.
Always delete a submission if:
The detail document Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, line 7 and 8, Applicable Large Employer Member (Employer), does not match the employer present on Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns.
Has changed box titles.
Cannot determine tax year.
Tax year of the transmittal and all the detail documents do not match.
It has an invalid (including subsequent) tax year document(s).
The incorrect detail document type is selected during "FI" .
The Form 1094 (series) return is missing either the name (line 1) or EIN (line 2) of the filer or employer.
Exception:
On Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, if Line 1-2 is blank and Line 9-10 is not blank, SCRIPS moves the Line 9-10 entity data to Line 1-2 entity data systemically after operator verification of the data fields.
The Form 1094 (series) return first four characters of the filer or employer name is illegible and is not retrievable within the submission.
3.41.267.9.7(01-01-2018)
Voiding a Supporting Detail Document
Only detail document Form 1095 (series).
Void a detail document if:
The void box on the top of the form is marked.
The form is crossed out or the word VOID is written over it.
Note:
The void box marked by the filer or employer makes all data on the form invalid.
The void box and corrected box both appear checked.
The only data on the document (detail) present is the Part I entity data AND the detail is not marked corrected (the CORRECTED box is not marked).
The form is a summary record in the submission.
Example:
The form is marked by the filer as a "summary" , "total" , or "subtotal" form.
The form is blank.
Detail documents (Form 1095 series) presented consecutively with the same responsible party or employee and the same covered individuals duplicated, enter one document and VOID the duplicate(s).
The printed physical form is missing data due to improper printing of the form by the taxpayer.
One or two Form 1095-C documents have a different employer than the rest of the documents.
You can determine several Form 1095-C documents do not belong in the submission.
DO NOT void a document (detail) if the system misread and placed an "X" in either the void or corrected boxes when one is not present on the document.
3.41.267.10(01-01-2018)
Re-Imaging Form 1094 Series Returns
The key allows you to flag or mark a Form 1094 (series) return to go to Image Only processing.
Perform Re-image (Image only) processing when the true and complete image is not clear or complete.
Re-image the return if any page of the return has processable taxpayer entries and the following exist:
Skewed, folded or otherwise unreadable
Scanned in backwards
3.41.267.11(01-01-2018)
1094 Series Image Only Processing
SCRIPS scanning function for image only processing and archiving is done for submissions processed for re-imaging (the key is used) or processed using OE paper. Only a true and complete image is taken for this purpose. To allow for retrieval of the image in the future, the DLN is key entered with each image. The menus shown on the screen depend on how your supervisor profiled you.
Example:
This option is not present on the Data Validation Function Menu if it is not in your profile.
3.41.267.11.1(01-01-2020)
1094 Image Only
From the Workstation Main Menu, select Data Validation (DV).
From the Data Validation (DV) Selection Menu, select "1094 Image Only."
A 1094 Image Only block opens a UW has up to 100 records/returns.
Note:
100 records or returns may equal more than 100 images due to multiple page records/returns.
If a document is not recognized by the scanner, a window opens allowing you to identify the image and page of each image of Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns. You can remove a single image or entire block from further processing. The window offers the options below:
DV Image Only Selection
Screen Selection
Form/Page/Form Identification NumberA
1094-B (Form Year ID 110116)
B
1094-C pg 1 (Form Year ID 120118)
C
1094-C pg 1 (Form Year ID 120117)
D
1094-C pg 2 (Form Year ID 120218)
E
1094-C pg 2 (Form Year ID 120217)
F
1094-C pg 3 (Form Year ID 120316)
X
Delete page
If the image is not either form type/page number, then press to remove the document from further processing.
Press -- or -- key combination to remove the entire block.
If the image is identified as a 1094 series form type page one the DLN is entered. If the document is removed or not a page 1, a DLN is not assigned.
If the record/return is the same block number, only the two-digit sequence number is entered. If the block number changes, then a enter the 14-digit DLN.
Whenever a 14-digit DLN is entered, the DLN is validated by requiring you to enter it twice. Each component of the DLN (i.e., the File Location Code, Tax Class, Document (Doc) Code, Julian Date, Blocking Series, Sequence Number and Year Digit) undergoes validation. Any invalid component generates an error message explaining the error.
3.41.267.12(01-01-2020)
Supervisor Section Affordable Care Act Return Program Reports
The following is a listing of the Affordable Care Act information return reports available on SCRIPS:
IRM 3.41.267.12.1, Document Locator Number (DLN) Output Report
IRM 3.41.267.12.2, Assigned Document Locator Number (DLN) Report
IRM 3.41.267.12.3, Cumulative Document Locator Number (DLN) Assignment Report
IRM 3.41.267.12.4, Workflow Status Report
IRM 3.41.267.12.5, Override Report
IRM 3.41.267.12.6, Inventory Report
IRM 3.41.267.12.7, Production Report
IRM 3.41.267.12.8, Run Balancing Report
IRM 3.41.267.12.9, Pull Unit of Work (Submission) Report
IRM 3.41.267.12.10, Throughput Statistics Report
IRM 3.41.267.12.11, Workstation Operator Statistics - Program and Function Summary Report
The following subsections have the content found on the report.
3.41.267.12.1(01-01-2016)
Document Locator Number (DLN) Output Report
The title of the report is IRP ACA DLN Output Report (IPS01118).
The report reflects the entire production for the site for a given time frame.
The report has the following:
Service Center
Run Date
Page number
Program number
DLNs and a notation if it is a transmittal DLN or detail DLN
File Location Code (FLC), Tax Class and Document Code (TAX/DOC), Julian date, Block number and Volume
3.41.267.12.2(01-01-2016)
Assigned Document Locator Number Report
The title of the report is IRP ACA Assigned DLN Report (IPS03339).
The report reflects production for the individual scanner for a given time frame.
The report has the following:
Program number
Run Date and Time
Scanner Job ID
Start Time
End Time
DLNs and a notation if it is a transmittal DLN or detail DLN
File Location Code (FLC), Tax Class and Document Code (TAX/DOC), Julian date, Block number and Volume
The summary page for the scan job by document code and form type
3.41.267.12.3(05-03-2017)
Cumulative Document Locator Number (DLN) Assignment Report
The title of the report is Cumulative DLN Assignment Report (IPS11110).
The report reflects the total number of DLN assignments by form type and form page time frame.
The report has the following:
Doc Code - Document Code
Four-digits, digit one and two is the document code
Digits three and four represent the page number
Form
form number followed by page number (P1, P2, P3, etc.)
Volume
Total
End Time
3.41.267.12.4(01-01-2020)
Workflow Status
The title of the report is Workflow Status (IPS0698)
This report lists the task/sub-task number, the sub-task description, blocks at the sub-task, total documents for the block, and documents ready for the sub-task. This report also has percentages for system capacity used under the following three categories: General, IRP, and IRP/ACA/K1/941/940/Stand-Alone.
This report is used to monitor documents and system capacity throughout each workday.
3.41.267.12.5(01-01-2018)
Override Report
The title of the report is IRP ACA Override Report (IPS11100).
The report reflects the total count of override keystrokes for a given time frame.
The report has the following:
Function Code
Doc Code - Document Code
two-digit number
Field Number
Field Description
Override Count
End Time
3.41.267.12.6(01-01-2016)
Inventory Report
The title of the report is Inventory Report (IPS03350).
The report reflects inventory for a given time frame reflecting the carry over form volume on the SCRIPS system.
The report has the following:
Initial Inventory
Process Date
Returns Input
Returns Deleted
Returns Output
Carry Over Inventory
End Time
3.41.267.12.7(02-19-2020)
Production Report
The title of the report is IRP ACA Production Report (IPS11120).
The report reflects the following scanned volumes and year to date output totals
The report has the following:
Service Center
Run Date and clock Time
Page number
Scanned volumes by document code and form type for today, subtotals and totals
Output volumes by document code and form type and deletes for year to date along with cumulative, subtotals and totals
Status summary for all functions for today/current and year to date cumulative
This report records ACA IRP production though the processing year and, as possible, daily activity and aids in validating production volume. Use this report for analyzing production reports for accuracy.
Site staff generates the IRP ACA Production Report late Friday or early Monday weekly and e-mails it by close of business Monday (or first workday of the work week) to National Office at *IT SCRIPS PO every week.
3.41.267.12.8(02-19-2016)
Run Balancing Report
The title of the report is IRP ACA Run Balancing Report (IPS01119).
The report reflects the entire production for the site for a given date.
The report has the following:
Service Center
Run Date
Page number
FTP File ID number
The file name (i.e., OCR1010B for forms in the B series and OCR1010C for forms in the C series)
3.41.267.12.9(01-01-2020)
Pull Unit of Work (Submission) Report
The title of the report is IRP ACA Pull Document/Submission Report (IPS00812).
The report lists submissions and documents to pull (or counted as deleted) for a date range.
The report has the following:
Service Center
Run Date and clock time
Page# - Number
Block#
Doc DLN/Seq# - Document DLN Sequence number
App - Application FI, OE or DV
SEID - Standard Employee Identification
Note:
An SEID of 000000 represents the SCRIPS system and creates the action based on programming and or specific responses to questions posed to the data entry clerk.
Date/Time
Reason
The reason is one of the following pull document report codes:
Reminder:
See IRM 3.41.267.4.2, Unprocessable Unit-of-Work Disposition, to determine the disposition of the UWs and documents pulled. Most of the pull report work requires forwarding to IRP Sort for correspondence as unprocessable documents. Tag each condition prior to forwarding to IRP Sort.
Report Reason
ConditionSINGLE ORIGINAL 1094-C
Standalone Original Form 1094-C
CONSECUTIVE PARENT
Two consecutive Form 1094-X
MISSING PARENT NAME
Name missing from Form 1094-B (Line 1) or Form 1094-C (Line 1 and Line 9) transmittal return
MISSING PARENT EIN
Missing valid nine-digit EIN on Form 1094 series return
MIXED SUBMISSION
Mixed form types
Example:
Marked “Remove” in FI.
INVALID TAX YEAR
Invalid Tax Year
PULL IMAGE ONLY
Marked “Remove” in Image Only
Note:
Requires rescanning.
PULL
F12 is pressed to remove document in OE/DV
PULL STANDALONE 1094-B
Standalone Form 1094-B
PULL IMAGE ONLY - NO DLN
F12 is pressed in Image Only on recognized document
Note:
Requires rescanning.
DEL UW- INVALID SSN/INVALID DOB
Threshold: Form 1095-B – Line 2/Line 3
DEL UW- INVALID DOB
Threshold: Form 1095-B – Line 3
DEL UW- INVALID ORIGIN OF POLICY
Threshold: Form 1095-B – Line 8
DEL UW- INVALID EINS
Threshold: Form 1095-B – Line 11
DEL UW - INVALID SSN/INVALID DOB
Threshold: Form 1095-B – Line 23(b)-40(b) SSN/DOB
DEL UW- INVALID DOB
Threshold: Form 1095-B – Line 23(c)-40(c) DoB
DEL UW- INVALID MONTH COMBO
Threshold: Form 1095-B – Line 23(d)-40(d) Months Covered
DEL UW - INVALID NAME
Threshold: Form 1094-C – Line 1
DEL UW- INVALID MISSING NAME/SSN
Threshold: Form 1095-C – Line 1/Line 2
DEL UW - INVALID SSNS
Threshold: Form 1095-C – Line 2
INVALID PLAN MONTH
Threshold: Form 1095-C – Plan Month
DEL UW - INVALID SSN/INVALID DOB
Threshold: Form 1095-C
Tax Year 2017-2019 = Line 17-34(b)-Line 17-34(c)
Tax Year ≥ 2020 = Line 18-30(b)-Line 18-30(c)
DEL UW- INVALID DOB
Threshold: Form 1095-C
Tax Year 2017-2019 = Line 17(c)-34(c) DoB
Tax Year ≥ 2020 = Line 18-30(c)
Physically pull only documents on the Pull Document Report for correspondence, Re-imaging or routing to some other function for action. You do not need to physically pull the following:
Blank pages
Instruction pages
Duplicate pages deleted by data entry clerks
Extraneous pages sent by the filer when the UW is sent to output successfully
3.41.267.12.10(05-03-2017)
Throughput Statistics Report
The title of the report is Throughput Statistics Report (IPS06440).
The report reflects processing function productions for a given date range.
The report rows reflect the following process functions: Scandriver, Transport/Sync, OE Crossover, Form Identification, Block Verification, OE Image, OE Paper, Program Validation, Data Validation, QR Summarization, Block Output, Image Archive, Backup Image Archive and Block Purge.
The report has the following:
Service Center
From and to date range and clock time
Run Date and clock time
Page Number
Processing Function
Total Blocks
Total Documents
Process Time
Documents Per Hour
3.41.267.12.11(05-03-2017)
Workstation Operator Statistics Program and Function Summary Report
The title of the report is Workstation Operator Statistics Program and Function Summary Report (IPS00803).
The report displays the number of documents processed in each function for a given date range.
Process function listed on the report rows: 460, 470, 480, 47X, and 48X.
The report has the following:
Service Center
From and to date range
Run Date and clock time
Page Number
Function Code
Program Number
Number of Documents
Process Time
Total Key Strokes
Keystrokes Per Hour
Documents Per Hour
Summary by Programs
3.41.267.13(01-01-2018)
Block Status Window
The Block Status window shows a more detailed status of the blocks/UWs in the search criteria data entered in the Block Search Criteria window.
A change of operational parameters of blocks/UWs is completed in the Block Status window. Depending on the parameter, a change to the parameter for individual blocks/UWs or multiple blocks/UWs is completed at the same time.
Press the -A key combination for selection of all blocks eligible for selection. This excludes blocks in a status of "DELETE" or "DONE" . The result is a check symbol mark on selected blocks in the Block Selected for Update column.
Press the -A key combination again to deselect all blocks if you choose to not perform updates on the selected blocks.
Press the -X key combination if you choose to cancel the blocks selected and close the Block Status window.
Block status monitoring (IPS0697) window shows a more detailed status of the blocks/UWs.
3.41.267.13.1(01-29-2019)
Output Verification Audit
An output verification process ran on all UWs prior to output systemically suspends any UW with invalid conditions in the UW, after DV.
Report UWs with invalid conditions appearing on the Block Status Monitoring window (IPS0697) to System Administrators (SA) for researched by the contractor.
A separate ticket is opened for each unique eleven or fourteen-digit DLN present on the report.
The reason is one of the following pull document report codes:
Reason Code
Status
Output Verification Audit/
DescriptionDUPDLN
SUSPND
Duplicate DLN across a block (11-digit DLN)
the block is previously output and therefore is a duplicate DLN
BADDLN
SUSPND
DLN is
not 14 characters in length
not numeric or
where characters four or five not valid document code
BADDOC
SUSPND
The block/UW has one or more documents not properly completed in the sub-task.
document status between one and 699 (700 is "normal" )
BADTIN
SUSPND
TIN not nine characters in length
not numeric
BADUW
SUSPND
Stand-alone Form 1094-B submission
stand-alone Form 1094-C submission, original (not corrected)
submission with no valid (non-deleted) documents
BADDAT
SUSPND
Form 1095-X document with a valid status and VOID box checked
Form 1094-B with no filer name, box 1 (a required field)
question marks on a non-voided document in any field with
any documents with a field equaling a status > 10 (not perfected) on a non-voided document
DELETE
Form 1094-C with no Applicable Large Employer (ALE) member name, box 1 (a required field)
3.41.267.14(01-01-2019)
Purging Documents
Purge from the SCRIPS system the files including the document images, ASCII data, and statistical information once the blocks/UWs of documents process through SCRIPS and reach "accepted" by down-stream processing, and the transmittals have moved to archive.
Note:
Accepted means the output files and "the returns in those files" clear all error conditions.
It is recommended a system purge occur a minimum of two (2) weeks after the output date.
Purge only those blocks/Units of Work (UWs) available for purge. The system keeps track of blocks/UWs available for purge and only allows you to purge those blocks/UWs. SCRIPS does not allow any blocks waiting for Quality Review (QR) Block Summarization or flagged for Quality Review to purge.
Do not purge files for reports before six weeks.
Exception:
Reports allow deletion after seven working days however six weeks is the preference.
A deleted document and/or block/UW is removed from the system when the form type is purged. The remainder of the form types on SCRIPS operate in the same manner.
Example:
Information return document (UW) is removed when an information return block purge is performed.
A purge for the form type is initiated and activated before removal of deleted documents/blocks/UWs from the system. If you open a purge window but do not select any blocks for purge, the deleted documents/blocks/UWs do not leave the system. Until the deletion is properly done Documents/blocks/UWs remain on the system.
Retained for 30 days after data is verified as converted to tape per Document 12990, Records Control Schedules, Record Control Schedule (RCS) 29, item 85, Information Returns, the physical documents (UWs scanned in the SCRIPS area). If systemic issues exist for downstream systems a longer period is enforced by headquarters staff.
Exhibit 3.41.267-1
Terms/Acronyms/Definitions
TERM/ACRONYM
DEFINITIONACA IR
ACA-IRP
IRP-ACA
Affordable Care Act form types in the Form 1094 (series) or Form 1095 (series) of returns.
Reminder:
These instructions cover only form types listed in IRM 3.41.267.2.1, Sources Documents.
ALE
Applicable Large Employer employs 50 or more full-time equivalent employees alone, is the controlling group entity or common owner of multiple business entities with employees as defined under aggregation rules.
ALE Member
Applicable Large Employer Member is part of a group business entity and employs 50 or more full-time equivalent employees.
Alpha Character
A character (letter) of the alphabet.
Alphanumeric Field
A field with both alpha and numeric characters.
APO
Army Post Office
Application
Refers to the system used for form type processed (i.e., IRP, ACA-IRP, Schedule K-1s, Form 940, Form 941, Stand-alone Schedule Rs).
Block DLN
The first 11-digits of 14-digit document locator number (DLN) consisting of a two-digit file location code, tax class, (tax class is always 5 for ACA-IRP), two-digit document type, three-digit Julian day, three-digit block number. Also see DLN.
Capture
The process of obtaining images of a document for character recognition and operator use.
Character
Any symbol or alpha (special or numeric) representing information.
Character Recognition
The process of converting information from paper images to digital data form.
Corrected Document
A return with the corrected box marked or a filer notation such as the word amended or corrected notated on the return.
Cursor
A vertical line showing the position where the next entry is keyed.
Data Fields
Those fields other than entity fields, e.g., on all documents listed such as: money amounts, dates, indicators, covered individuals, etc.
Detail Document
Every Form 1095 (series) also referred to as supporting return or document or a child return.
DLN
(Document Locator Number)
A 14-digit document locator number consisting of a two-digit file location code, tax class, (tax class is always "5" for ACA-IRP), two-digit document type, three-digit Julian day, three-digit block number, two-digit sequence number and a year digit. Also see Block DLN.
DoB, DOB
(Date of Birth)
A date consisting of a month, day and year combination.
Caution:
Any of the three missing means the remaining combinationis not a DoB. Do not enter anything in the field without all three things present or determined.
Document Code
(Doc Code)
The fourth and fifth position of each DLN identifying the type of return the electronic data record has captured. The following is the document code- form number and form title for ACA-IRs.
11 - Form 1094-B, Transmittal of Health Coverage Information Returns
12 - Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
56 - Form 1095-B, Health Coverage
60 - Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
DPO
Diplomatic Post Office
EIN
An employer identification number (a nine-digit number) typically identifies an entity such as a corporation, a trust, a nonprofit association, or a sole proprietor whose module resides on the business master file. Usually in NN-NNNNNNN format.
Employee
A recipient listed in Part I of Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, issued by their employer (ALE).
Entity/Entity Fields
The part of the document where the TIN, name, and requests an address present for the entries.
Field
Specific area provided for data entry.
Filer
The entity listed on the transmitting Form 1094 (series) always a business entity with a corresponding employer identification number (EIN) or the employer.
Flag
A question mark used to designate an unrecognizable character, or an error within a field. also flags a Form 1094 series for re-image.
File Location Code (FLC)
A two-digit number designed to represent the Service Center where an action is taken on a taxpayer module. The action is a transaction representing a return filing or subsequent compliance action.
Form Identification Number
(Form ID)
A six-digit number located at the top right of each page of a SCRIPS ACA-IRP document.
First two-digits = Document Code
Third and fourth digit = Page number of the return
Fifth and sixth number = Year the template (layout or landscape placement) is last updated/changed
FPO
Fleet Post Office
Function Keys
The upper row of keys on the SCRIPS keyboard. The function keys through .
Highlighting
A three-dimensional shadowing of a template field used to direct attention to the field. Used in OE to show the current cursor position. Used in DV to show the current cursor position, and the current field with the error.
The -5 function key highlights the corresponding field on the image template.
Image Strip
A section of the true and complete image magnified and displayed above the template. The image strip displayed is a magnified version of the corresponding field highlighted on the image.
Pressing -3 toggles the image strip on and off.
Key Combination
Keystroke commands requiring two or more simultaneous key presses.
Example:
Press -P or post-to-close means to press and hold the key and then press the
key before releasing the key.
Menu
A list of operations/options the workstation operator selects.
Message Window
A window appearing within the main window. It usually appears in the center of the screen. The system uses these windows to relay messages to the operator.
NABR
Name and Address Block Reader compares the address captured from the scanner and the United States Postal Service database of addresses.
Non-Conforming Form
A form the scanner cannot recognize.
Numeric Character
A number ranging from 0 to 9. A digit.
Original Document
A return without a corrected box marked or amended or corrected notated by the filer on the return.
Prompt
A message or statement displayed requiring an operator response.
Recipient
The individual taxpayer listed in Part I of the Form 1095 (series) return who is the employee or responsible party.
Responsible Individual
The entity listed in Part 1 of Form 1095-B, Health Coverage, who is the holder, controller or owner of the insurance policy.
SA1094C
Stand-alone Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, with no details.
See IRM 3.41.267.2.1 (1), Source Documents, for more information.
Sequence Number/ Serial Number (SN)
A two-digit number located at positions 12 and 13 within the DLN and uniquely identifies the document.
Sight-Verify
Examine a highlighted field in DV. If correct, release the field. If incorrect, correct the field. Also, called verify.
Social Security Number (SSN)
A nine-digit number issued to an individual by the Social Security Administration. The IRS uses this number to process tax documents and returns. Usually in NNN-NN-NNNN format.
Special Characters (symbols)
*, &, /, -, %, #, ?, etc.
Note:
Ampersand "&" is not considered a special character in the name line entry.
Status Line
A strip of information found along the bottom right side of the main working window below the prompt area. Indicates the program number, DLN/SN, document count, and auto, Insert and Numeric indicators.
Submission
A Form 1094 (series) return with associated detail documents, Form 1095 (series), or a SA1094C. Also, called a unit-of-work (UW).
Template
A window with fields for data entry. The template mirrors the actual form layout, to the fullest extent possible.
TIN
Taxpayer Identification Number. Either an EIN or an SSN.
Transmittal
(Parent document)
(Parent return)
A Form 1094-B, Transmittal of Health Coverage Information Returns, or Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, filed with the IRS.
True and Complete Image
The image the system displays for data entry or validation purposes. If available, the system always displays it on the left half of the monitor screen.
Unit-of-Work (UW)
A group of ACA-IRP documents with one Form 1094 (series) transmittal and corresponding Form 1095 (series) returns or one SA1094C as defined. SCRIPS controls a unit-of-work by the Form 1094 (series) 14-digit DLN.
YYTY
The tax year processed normally current year minus one.
YYPY
The current processing year normally the current year. Term used to eliminate dates on form prompts changing each year.
Exhibit 3.41.267-2
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by State
If the ZIP Code is missing or invalid, add 01 to the first three-digit ZIP Code shown.
STATE
STATE CODE
ZIP CODE RANGEAlabama
AL
350-369
Alaska
AK
995-999
America Samoa
AS
96799 (only)
Americas APO/DPO/FPO
AA
340
Arizona
AZ
850-865
Arkansas
AR
716-729
California
CA
900-908, 910-961
Colorado
CO
800-816
Connecticut
CT
060-069
Delaware
DE
197-199
District of Columbia
DC
200, 202-205
Europe APO/DPO/FPO
AE
090-098
Federated States of Micronesia
FM
969
Florida
FL
320-342, 344, 346, 347, 349
Georgia
GA
300-319, 399
Guam
GU
969
Hawaii
HI
967, 968
Idaho
ID
832-838
Illinois
IL
600-629
Indiana
IN
460-479
Iowa
IA
500-528
Kansas
KS
660-679
Kentucky
KY
400-427
Louisiana
LA
700-714
Maine
ME
039-049
Marshall Islands
MH
969
Maryland
MD
206-219
Massachusetts
MA
010-027, 055
Michigan
MI
480-499
Minnesota
MN
550-567
Mississippi
MS
368-397
Missouri
MO
630-658
Montana
MT
590-599
Nebraska
NE
680-693
Nevada
NV
889-898
New Hampshire
NH
030-038
New Jersey
NJ
070-089
New Mexico
NM
870-884
New York
NY
005, 100-149
North Carolina
NC
270-289
North Dakota
ND
580-588
Northern Mariana Islands
MP
969
Ohio
OH
430-459
Oklahoma
OK
730-732, 734-749
Oregon
OR
970-979
Pacific APO/DPO/FPO
AP
962-966
Palau
PW
969
Pennsylvania
PA
150-196
Puerto Rico
PR
006, 007, 009
Rhode Island
RI
028, 029
South Carolina
SC
290-299
South Dakota
SD
570-577
Tennessee
TN
370-385
Texas
TX
733, 750-799
Utah
UT
840-847
Vermont
VT
050-054, 056-059
Virginia
VA
201, 220-246
Virgin Islands
VI
008
Washington
WA
980-986, 988-994
West Virginia
WV
247-268
Wisconsin
WI
530-549
Wyoming
WY
820-831
Exhibit 3.41.267-3
States, State Codes, and Zone Improvement Plan (ZIP) Codes Sorted by ZIP Code
If the ZIP Code is missing or invalid, add 01 to the first three-digit ZIP Code shown.
ZIP CODE RANGE
STATE CODE
STATE005, 100-149
NY
New York
006, 007-009
PR
Puerto Rico
008
VI
Virgin Islands
010-027, 055
MA
Massachusetts
028, 029
RI
Rhode Island
030-038
NH
New Hampshire
039-049
ME
Maine
050-054, 056-059
VT
Vermont
060-069
CT
Connecticut
070-089
NJ
New Jersey
090-098
AE
Europe APO/DPO/FPO
150-196
PA
Pennsylvania
197-199
DE
Delaware
200, 202-205
DC
District of Columbia
201, 220-246
VA
Virginia
206-219
MD
Maryland
247-268
WV
West Virginia
270-289
NC
North Carolina
290-299
SC
South Carolina
300-319, 399
GA
Georgia
320-342, 344, 346, 347, 349
FL
Florida
340
AA
Americas APO/DPO/FPO
350-369
AL
Alabama
370-385
TN
Tennessee
386-397
MS
Mississippi
400-427
KY
Kentucky
430-459
OH
Ohio
460-479
IN
Indiana
480-499
MI
Michigan
500-528
IA
Iowa
530-549
WI
Wisconsin
550-567
MN
Minnesota
570-577
SD
South Dakota
580-588
ND
North Dakota
590-599
MT
Montana
600-629
IL
Illinois
630-658
MO
Missouri
660-679
KS
Kansas
680-693
NE
Nebraska
700-714
LA
Louisiana
716-729
AR
Arkansas
730-732, 734-749
OK
Oklahoma
733, 750-779
TX
Texas
800-816
CO
Colorado
820-831
WY
Wyoming
832-838
ID
Idaho
840-847
UT
Utah
850-865
AZ
Arizona
870-884
NM
New Mexico
889-898
NV
Nevada
900-908, 910-961
CA
California
962-966
AP
Pacific APO/DPO/FPO
96799 (only)
AS
American Samoa
967, 968
HI
Hawaii
969
PW
Palau
969
GU
Guam
969
MP
Marianna Islands
970-979
OR
Oregon
980-986, 988-994
WA
Washington
995-999
AK
Alaska
Exhibit 3.41.267-4
Zone Improvement Plan (ZIP) Code, City, and State Exceptions
Exceptions to ZIP where State ZIP Code is five-digits
ZIP
CITY
STATE75502
Texarkana
AR
45275
Airport
KY
71749
Junction City
LA
03801
Naval Base
ME
20331
Andrews AFB
MD
06390
Fishers Island
NY
73949
Texhoma
TX
20041
Dulles Int'l Airport
VA
20370
Navy Annex
VA
20301
Pentagon
VA
49936
Alvin
WI
Exhibit 3.41.267-5
Alphabetical Listing of Major Cities with Major City Codes and Zone Improvement Plan (ZIP) Codes
Major City
State Code
Major City Code
ZIP CodeAberdeen
SD
AD
574
Abilene
TX
AB
796
Akron
OH
AK
443
Albany
GA
AY
317
Albany
NY
AL
122
Albuquerque
NM
AQ
871
Alexandria
VA
AX
223
Alhambra
CA
YA
918
Allentown
PA
AW
181
Amarillo
TX
AM
791
Anaheim
CA
AH
928
Anchorage
AK
AN
995-996
Anderson
SC
AJ
296
Ann Arbor
MI
AP
481
Arlington
TX
IA
760
Arlington
VA
AR
222
Arvada
CO
AV
800, 804
Asheville
NC
AS
288
Athens
GA
AE
306
Atlanta
GA
AT
303, 311, 399
Atlantic City
NJ
AC
084
Auburn
AL
AF
368
Augusta
GA
AG
309
Augusta
ME
AA
043
Aurora
CO
AZ
800
Aurora
IL
AO
605
Austin
TX
AU
733, 787
Bakersfield
CA
BD
933
Baltimore
MD
BA
212
Baton Rouge
LA
BR
708
Battle Creek
MI
QK
490
Beaumont
TX
BT
777
Bellingham
WA
BH
982
Berkeley
CA
BE
947
Bethlehem
PA
BM
180
Billings
MT
IB
591
Biloxi
MS
BL
395
Binghamton
NY
BC
139
Birmingham
AL
BI
352
Bismarck
ND
BB
585
Bloomington
IN
BQ
474
Bloomington
MN
BN
554
Boca Raton
FL
BZ
334
Boise
ID
BS
837
Bossier City
LA
BW
711
Boston
MA
BO
021, 022
Boulder
CO
BV
803
Bradenton
FL
BG
342
Bremerton
WA
BY
983
Bridgeport
CT
BP
066
Bronx
NY
BX
104
Brooklyn
NY
BK
112
Brownsville
TX
BJ
785
Buffalo
NY
BF
142
Burlington
VT
BU
054
Cambridge
MA
CB
021, 022
Camden
NJ
CD
081
Canton
OH
CA
447
Cape Coral
FL
CF
339
Casper
WY
CZ
826
Cedar Rapids
IA
CR
524
Champaign
IL
CX
618
Chandler
AZ
YZ
852
Chapel Hill
NC
CJ
275
Charleston
SC
CT
294
Charleston
WV
CW
253
Charlotte
NC
CE
282
Charlottesville
VA
CV
229
Chattanooga
TN
CG
374
Chesapeake
VA
CP
233
Cheyenne
WY
CY
820
Chicago
IL
CH
606-608
Chula Vista
CA
DV
919
Cincinnati
OH
CN
452, 459
Clarksville
TN
YN
370
Clearwater
FL
CQ
337
Cleveland
OH
CL
441
Colorado Springs
CO
CS
809
Columbia
SC
CU
292
Columbus
GA
CM
318, 319
Columbus
OH
CO
430, 432
Corpus Christi
TX
CC
783, 784
Cranston
RI
RT
029
Cumberland
MD
CK
215
Dallas
TX
DA
752, 753
Davenport
IA
DP
528
Dayton
OH
DY
453, 454
Daytona Beach
FL
DF
321
Dearborn
MI
DB
481
Decatur
IL
DT
625
Denver
CO
DN
800-802
Des Moines
IA
DM
503, 509
Detroit
MI
DE
482
Dubuque
IA
DQ
520
Duluth
MN
DL
557, 558
Durham
NC
DU
277
East Lansing
MI
ET
488
East Orange
NJ
EO
070
East St Louis
IL
ES
622
Easton
PA
EA
180
El Paso
TX
EP
799, 885
Elizabeth
NJ
EL
072
Erie
PA
ER
165
Eugene
OR
EU
974
Evanston
IL
EN
602
Evansville
IN
EV
477
Fairbanks
AK
FK
997
Fall River
MA
FR
027
Far Rockaway
NY
RK
110, 116
Fargo
ND
FA
581
Fayetteville
AR
FB
727
Fayetteville
NC
FN
283
Flint
MI
FT
485
Florence
AL
FC
356
Florence
SC
FE
295
Flushing
NY
FG
113
Fort Lauderdale
FL
FL
333
Fort Pierce
FL
FP
349
Fort Smith
AR
FS
729
Fort Wayne
IN
FY
468
Fort Worth
TX
FW
761
Fresno
CA
FO
936-938
Gainesville
FL
GF
326
Gaithersburg
MD
GG
208
Galveston
TX
GA
775
Garland
TX
GD
750
Gary
IN
GY
464
Gastonia
NC
GN
280
Glendale
AZ
GE
853
Glendale
CA
GL
912
Grand Rapids
MI
GR
495
Great Falls
MT
GT
594
Greeley
CO
GC
806
Green Bay
WI
GB
543
Greensboro
NC
GO
274
Greenville
SC
GV
296
Greenwood
MS
GW
389
Hackensack
NJ
HS
076
Hamilton
OH
HA
450
Hammond
IN
HM
463
Hampton
VA
HP
236
Harlingen
TX
HR
785
Hartford
CT
HD
061
Harrisburg
PA
HG
171
Hattiesburg
MS
HT
394
Helena
MT
HE
596
Henderson
NV
HF
890
Hialeah
FL
HI
330
High Point
NC
HC
272
Hollywood
FL
HW
330
Honolulu
HI
HL
968
Houston
TX
HO
770, 772
Huntington
WV
HN
257
Huntington Beach
CA
HB
926
Huntsville
AL
HU
358
Independence
MO
IE
640
Indianapolis
IN
IN
462
Inglewood
CA
ID
903
Irvine
CA
IV
926, 927
Irving
TX
IR
750
Jackson
MS
JN
392
Jacksonville
FL
JV
322
Jamaica
NY
JA
114
Jamestown
NY
JM
147
Janesville
WI
JE
535
Jersey City
NJ
JC
070, 073
Johnson City
TN
JH
376
Johnstown
PA
JO
159
Joliet
IL
JT
604
Jonesboro
AR
JB
724
Kalamazoo
MI
KZ
490
Kansas City
KS
KA
661
Kansas City
MO
KC
641, 649
Kennewick
WA
KW
993
Kenosha
WI
KE
531
Kingsport
TN
KP
376
Knoxville
TN
KN
379
Lafayette
IN
LF
479
Lafayette
LA
LL
705
Lake Charles
LA
LC
706
Lakeland
FL
LK
338
Lakewood
CO
LW
801, 802, 804
Lancaster
PA
LP
176
Lansing
MI
LG
489
Laredo
TX
LD
780
Las Cruces
NM
LZ
880
Las Vegas
NV
LV
891
Lawrence
MA
LQ
018
Lewiston
ME
LT
042
Lexington
KY
LX
405
Lincoln
NE
LN
685
Little Rock
AR
LR
722
Long Beach
CA
LB
907, 908
Long Island City
NY
LI
111
Lorain
OH
LO
440
Los Angeles
CA
LA
900, 901
Louisville
KY
LE
402
Lowell
MA
LM
018
Lubbock
TX
LU
794
Lynn
MA
LY
019
Macon
GA
MA
312
Madison
WI
MN
537
Manchester
NH
MR
031
Marietta
GA
MT
300
Melbourne
FL
ML
329
Memphis
TN
ME
375, 381
Meridian
MS
MD
393
Mesa
AZ
MZ
852
Metairie
LA
MI
700
Miami
FL
MF
330-332
Milwaukee
WI
MW
532
Minneapolis
MN
MS
554
Missoula
MT
MM
598
Mobile
AL
MO
366
Modesto
CA
MC
953
Monroe
LA
MB
712
Montgomery
AL
MG
361
Muskegon
MI
MK
494
Naperville
IL
NP
605
Nashua
NH
NS
030
Nashville
TN
NA
372
Newark
NJ
NK
071
New Bedford
MA
ND
027
New Brunswick
NJ
NB
089
New Haven
CT
NH
065
New Orleans
LA
NO
701
Newport News
VA
NN
236
Newton
MA
NE
024
New York
NY
NY
100-102
Niagara Falls
NY
NF
143
Norfolk
VA
NV
235
Norman
OK
NR
730
North Charleston
SC
NC
294
North Hollywood
CA
NW
916
North Las Vegas
NV
NT
890
North Little Rock
AR
NL
721
Oakland
CA
OA
946
Oak Park
IL
OP
603
Oceanside
CA
OE
920
Ogden
UT
OG
842, 844
Oklahoma City
OK
OC
731
Olympia
WA
OL
985
Omaha
NE
OM
681
Orlando
FL
OR
328
Oshkosh
WI
OK
549
Overland Park
KS
OV
662
Owensboro
KY
OW
423
Oxnard
CA
OX
930
Palo alto
CA
PQ
943
Parkersburg
WV
PK
261
Parma
OH
PZ
441
Pasadena
CA
PD
910, 911
Paterson
NJ
PN
075
Pembroke Pines
FL
PP
330
Pensacola
FL
PE
325
Peoria
AZ
PY
853
Peoria
IL
PL
616
Petersburg
VA
PG
238
Philadelphia
PA
PH
190-192
Phoenix
AZ
PX
850
Pine Bluff
AR
PB
716
Pittsburgh
PA
PI
151, 152
Pocatello
ID
PC
832
Port Arthur
TX
PA
776
Portland
ME
PT
041
Portland
OR
PO
972
Portsmouth
NH
PS
038
Portsmouth
VA
PM
237
Providence
RI
PR
029
Provo
UT
PV
846
Pueblo
CO
PU
810
Punta Gorda
FL
PJ
339
Quincy
MA
QU
021, 022
Racine
WI
RA
534
Raleigh
NC
RL
276
Reading
PA
RD
196
Reno
NV
RE
895
Richmond
VA
RI
231, 232
Riverside
CA
RS
925
Roanoke
VA
RO
240
Rochester
NY
RC
146
Rock Hill
SC
RH
297
Rockford
IL
RF
611
Sacramento
CA
SC
942, 958
Saginaw
MI
SG
486
Salem
OR
XR
973
Salinas
CA
YL
939
Salt Lake City
UT
XU
841
San Antonio
TX
SO
782
San Bernardino
CA
SR
924
San Diego
CA
SD
921
San Francisco
CA
SF
941
San Jose
CA
SJ
951
San Juan
PR
XJ
009
Santa Ana
CA
SA
927
Santa Barbara
CA
SZ
931
Santa Fe
NM
YF
875
Sarasota
FL
XS
342
Savannah
GA
GS
314
Schenectady
NY
SK
120, 123
Scottsdale
AZ
YS
852
Scranton
PA
XC
185
Seattle
WA
SE
981
Shawnee Mission
KS
SM
662
Sheboygan
WI
XB
530
Shreveport
LA
SH
711
Silver Spring
MD
SS
209
Sioux City
IA
SX
511
Sioux Falls
SD
IQ
571
South Bend
IN
SB
466
Spartanburg
SC
SQ
293
Spokane
WA
SW
992
Springfield
IL
XL
627
Springfield
MA
XA
011
Springfield
MO
XO
657, 658
Springfield
OH
XH
455
Stamford
CT
ST
069
Staten Island
NY
SI
103
St Joseph
MO
XM
645
St Louis
MO
SL
631
St Paul
MN
SU
551
St Petersburg
FL
SP
337
Sterling Heights
MI
YH
483
Stockton
CA
SN
952
Syracuse
NY
SY
132
Tacoma
WA
TC
984
Tallahassee
FL
TL
323
Tampa
FL
TA
336
Tempe
AZ
TE
852
Terre Haute
IN
TH
478
Titusville
FL
TT
327
Toledo
OH
TO
436
Torrance
CA
TN
905
Topeka
KS
TP
666
Trenton
NJ
TR
086
Tucson
AZ
TU
857
Tulsa
OK
TS
741
Tuscaloosa
AL
TB
354
Utica
NY
UT
135
Van Nuys
CA
VN
913, 914
Vancouver
WA
VA
986
Virginia Beach
VA
VB
234
Waco
TX
WX
767
Warren
MI
WR
480
Warren
OH
WO
444
Warwick
RI
WW
028
Washington
DC
DC
200, 202-205, 569
Waterbury
CT
WT
067
Waterloo
IA
WL
507
West Allis
WI
WA
532
West Valley City
UT
WC
841
West Palm Beach
FL
WP
334
Westminister
CO
WD
800, 802
Wheeling
WV
WH
260
White Plains
NY
WJ
106
Wichita
KS
WK
672
Wichita Falls
TX
WF
763
Wilkes-Barre
PA
WB
187
Williamsport
PA
WM
177
Wilmington
DE
WI
198
Wilmington
NC
WN
284
Winston-Salem
NC
WS
271
Winter Haven
FL
WG
338
Worcester
MA
WE
016
Yonkers
NY
YK
107
York
PA
YR
173, 174
Youngstown
OH
YO
445
Exhibit 3.41.267-6
Affordable Care Act Information Return Transcription Sheets
OE/DV Screen Prompt
Description
Instructions
Form 1094-B, Transmittal of Health Coverage Information ReturnsTax Year
(located top right-hand of form)
The tax year is a must enter field entry.
Enter the tax year printed/present in the upper right-hand corner of the form.
Requires two consecutive matching and valid entries to leave the field.
Reminder:
Valid tax years - 2017, 2018, 2019 and, 2020.
Enter "00" if an invalid tax year is present. Then select "yes" when prompted to delete the UW.
Note:
The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field.
Delinq. Indicator
First box
For Official Use Only
Enter the code, if present, from the first For Official Use Only box.
Notes:
If the box is blank, check if it is present in the top margin of the document.
If the code is ≡ ≡ ≡ ≡≡ ≡≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡≡ ≡ ≡≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡, do not enter data in the Delinq. Return Date field.
If the code is ≡ ≡≡ ≡ ≡ ≡ enter the valid date in the Delinq. Return Date field.
Delinq. Return Date
Date stamp in white space of
For Official Use Only
Enter the date from the IRS received date stamp, if present.
If blank, enter the date from the IRS received date stamp in MMDDYY format see the valid dates below.
If multiple conflicting received dates present or the received date stamp is circled out leave blank.
If the received date stamp is illegible, enter the signature date. If the signature date is illegible, missing, or timely, leave blank.
The valid dates:
≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡.
If the ≡ ≡ ≡ ≡ is missing and a valid Delinquent Date is present in the Delinquent Return Date field, enter an "≡".
If the received date present is not valid remove the "≡ ≡ ≡" from the Delinquent Indicator field.
Corr. Ind
Correspondence Indicator
DO NOT enter any codes present from the last two For Official Use Only boxes. Press .
Line 1- Filer's Name
Filer’s name
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present delete the UW from the system. Press .
Line 2-EIN
Employer identification number (EIN)
Enter the nine-digit EIN present.
Caution:
Delete the UW by entering all zeros in the EIN field when:
- the TIN is missing or is more than or less than nine-digits
- any digit is illegible, and the filer entity is not present on the first detail
- single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 is entered as the EIN.
Line 3-Name of Contact
Name of person to contact
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press .
Line 4-Contact Phone
Contact telephone number
Enter up to the first twelve numbers if present.
Is blank, 7, 10, or 12 numerics.
Note:
Extensions optional.
Line 5-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 6-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 7-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 8-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the country and/or foreign postal code.
Line 9-Total 1095-B
Total number of Forms 1095-B submitted with this transmittal
Enter the number present on the document.
OE/DV Screen Prompt
Page 1
Description
Page 1
Instructions
Form 1095-BHealth Coverage - Page 1Tax Year
(located top right-hand of form)
The tax year is a must enter field entry.
Enter the tax year printed/present in the upper right-hand corner of the form.
Requires two consecutive matching and valid entries to leave the field.
Enter "00" when an invalid tax year is present, or the year does not match the transmittal.
Reminder:
Valid tax years - 2017, 2018, 2019 and, 2020.
Then select "yes" when prompted to delete the return.
Note:
The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field.
VOID Box
VOID Box
Enter "X" if marked.
Note:
All data on the form is invalid if the filer marks the void box, writes void on the form, marks through the entire form or the SCRIPS operator has voided the return due to duplication within the submission.
CORRECTED Box
CORRECTED Box
Enter "X" if marked.
Tax Year ≥ 2018
Line 1-Resp. First Name
First name
Enter the first name if present or you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial and last name place the entire name in last/full name.
Tax Year ≥ 2018
Line 1-Resp. Middle Initial
Middle initial
Enter the middle initial if present or you can determine it.
Tax Year ≥ 2018
Line 1-Resp. Last/Full Name
Last name/Full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Tax Year 2017
Line 1-Resp. Name
Name of responsible individual
Enter the full name shown.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Line 2-SSN or other TIN
Social security number (SSN)
Enter the nine-digit SSN or TIN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If 50 percent or more of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Line 3-Date of Birth
Date of birth (if SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD or YYYY is missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Line 4-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 5-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 6-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 7-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Line 8-Origin of Policy
Enter letter identifying Origin of the Policy...▸
Enter the alpha character present.
Tax Year 2020 valid characters: "A" through "G".
Tax Years 2019, 2018, 2017 valid characters: "A" through "F".
If multiple characters present enter the first valid character.
If no valid character is present blank the field.
Line 10-Emp. Name
Employer name
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces.
Line 11-EIN
Employer identification number
Enter the nine-digit EIN present. If the EIN is:
Missing enter nothing
Is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit
Line 12-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 13-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 14-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 15-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Line 16-Name
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces.
Line 17-EIN
Enter the nine-digit EIN present.
If the EIN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Line 18-Contact Phone
Contact telephone number
Enter up to the first twelve numbers if present.
Is blank, 7, 10, or 12 numerics.
Note:
Extensions optional.
Line 19-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 20-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 21-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 22-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Tax Year ≥ 2018
Line 23(a)-Covered Ind.
through
Line 28(a)-Covered Ind. First Name
First name
Enter the first name if present or if you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial and last name place the entire name in last/full name.
Enter suffixes after the last name entry.
Tax Year ≥ 2018
Line 23(a)-Covered Ind.
through
Line 28(a)-Covered Ind. Middle Initial
Middle initial
Enter the middle initial if present or you can determine it.
Tax Year ≥ 2018
Line 23(a)-Covered Ind.
through
Line 28(a)-Covered Ind. Last Name
Last/Full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Note:
Instructions repeat for all entries for each covered individual listed on line 23, columns (a, b, c, d, and e) through line 28, columns (a, b, c, d, and e).
Tax Year 2017
Line 23(a)-Covered Ind.
through
Line 28(a)-Covered Ind.
Name of covered individual(s)
Enter the full name shown.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Note:
Instructions repeat for all entries for each covered individual listed on line 23, columns (a, b, c, d, and e) through line 28, columns (a, b, c, d, and e).
Line 23(b)-SSN or other TIN
through
Line 28(b)-SSN or other TIN
SSN
Enter the nine-digit SSN or TIN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If 50 percent or more of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 23(c)-DoB
through
Line 28(c)-DoB
DOB (If SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD or YYYY appear missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 23(d)-12 Months
through
Line 28(d)-12 Months
Covered all 12 months
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 23(e)-Jan
through
Line 28(e)-Dec
Months of coverage Jan through Dec
Enter "X" if marked.
Note:
Instructions repeat for all entries for each covered individual listed on line 23, columns (a, b, c, d, and e) through line 28, columns (a, b, c, d, and, e).
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
OE/DV Screen Prompt
Page 3
Description
Page 3
Instructions
Form 1095-B, Health Coverage - Page 3SSN or other TIN
Social security number (SSN)
Enter the nine-digit SSN or TIN present.
Enter a period for illegible characters.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Date of Birth
Date of birth (if SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD or YYYY is missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Tax Year ≥ 2018
Line 29a)-Covered Ind.
through
Line 40)-Covered Ind. First Name
First name
Enter the first name if present or you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in last/full name.
Tax Year ≥ 2018
Line 29a)-Covered Ind.
through
Line 40)-Covered Ind. Middle Initial
Middle initial
Enter the middle initial if present or you can determine it.
Tax Year ≥ 2018
Line 29a)-Covered Ind.
through
Line 40)-Covered Ind.
Last name/Full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Note:
Instructions repeat for all entries for each covered individual listed on line 23 (columns a, b, c, d, and, e) through line 40 (columns a, b, c, d, and, e).
Tax Year 2017
Line 29a)-Covered Ind.
through
Line 40)-Covered Ind.
Name of covered individual(s)
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Note:
Instructions repeat for all entries for each covered individual listed on line 23 (columns a, b, c, d, and, e) through line 40 (columns a, b, c, d, and, e).
Line 29b)-SSN or other TIN
through
Line 40)-SSN or other TIN
SSN
Enter the nine-digit SSN or TIN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 29c)-DoB
through
Line 40)-DoB
DOB (If SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD, or YYYY appear missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 29d)-12 Months
through
Line 40)-12 Months
Covered all 12 months
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 29e)-Jan
through
Line 40)-Dec
Months of coverage Jan through Dec
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
OE/DV Screen Prompt
Page 1
Description
Page 1
Instructions
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 1Tax Year
(located top right-hand of form)
The tax year is a must enter field entry.
Enter the tax year printed/present in the upper right-hand corner of the form.
Requires two consecutive matching and valid entries to leave the field.
Enter "00" if an invalid tax year is present.
Reminder:
Valid tax years: 2017, 2018, 2019 and 2020.
Then select "yes" when prompted to delete the UW.
Note:
The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field.
Corrected
CORRECTED Box
Enter "X" if marked.
Delinq. Indicator
First box
For Official Use Only
Enter the code, if present, from the first For Official Use Only box.
Notes:
If the box is blank, look for a code in the top margin of the document.
If the code is ≡ ≡≡ ≡ ≡≡ ≡ ≡≡ ≡≡ ≡≡ ≡≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡, do not enter data in the Delinq. Return Date field.
If the code is "≡ ≡ ≡ ≡", enter the valid date in the Delinq. Return Date field.
Delinq. Return Date
Date stamp in white space of
For Official Use Only
Enter the date from the IRS received date stamp, if present.
If blank, enter the date from the IRS received date stamp in MMDDYY format see the valid dates below.
If multiple conflicting received dates present or the received date stamp is circled out leave blank.
If the received date stamp is illegible, enter the signature date. If the signature date is illegible, missing, or timely, leave blank.
The valid dates:
≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡≡ ≡ ≡ ≡≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡ ≡
If the "≡ ≡" is missing and a valid Delinquent Date is present in the Delinquent Return Date field, enter an "≡ ≡ ≡".
If the received date is not valid remove the "≡ ≡ ≡" from the Delinquent Indicator field.
Corr. Ind
Correspondence Indicator
DO NOT enter any codes present from the last two For Official Use Only boxes. Press .
Line 1-ALE Member
Name of ALE Member (Employer)
Enter the full name as shown if present.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If the name is missing and is not present press .
See IRM 3.41.267.9.2, Name Entry, for more instruction on filers names.
Line 2-EIN
Employer identification number
Enter the nine-digit EIN present.
If the EIN is missing, incomplete, invalid, or more than or less than nine-digits then check the first detail document for the EIN. If present enter on Line 2- EIN.
If the EIN is not present on the first detail AND line 9 and line 10 appear blank, then enter nine zeros (000000000) to delete the UW.
If there is no entry on line 1 and 2 and there is an entry on line 9 and line 10 the system moves the entity on line 9 and line 10 to line 1 and line 2 systemically.
If the EIN is a single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 or is more than or less than nine-digits and the correct EIN is not present on the first detail then enter nine zero (000000000) to delete the UW.
Line 3-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 4-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 5-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 6-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Line 7-Name of Contact
Name of person to contact
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press .
Line 8-Contact Phone
Contact telephone number
Enter up to the first twelve numbers if present.
Is blank, 7, 10, or 12 numerics.
Note:
Extensions optional.
Line 9-Designated Name
Name of Designated Government Entity (only if applicable)
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press .
Note:
If there is no ALE data present on Line 1 and 2, and valid data is verified on Line 9 and 10 the designated entity data is moved to the ALE entity data systemically.
Line 10-EIN
Employer identification number (EIN)
Enter the nine-digit EIN present.
If the TIN is illegible enter period.
If the TIN is missing digits enter periods for the missing digits.
If the TIN is more than nine-digits enter the first nine-digits present.
If the TIN appears in SSN format enter nothing. If missing or is not present press .
Line 11-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 12-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 13-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 14-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Line 15-Name of Contact
Name of person to contact
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. If the name is missing and is not present press .
Line 16-Contact Phone
Contact telephone number
Enter up to the first twelve numbers if present.
Is blank, 7, 10, or, 12 numerics.
Note:
Extensions optional.
Line 18-Total 1095-Cs
Total number of Forms 1095-C submitted with this transmittal
Enter the number present on the document.
Line 19-Authoritative ALE Member
Is this the authoritative transmittal for this ALE Member? If “yes,” check the box and continue...
Enter "X" if marked.
Line 20-Total 1095-C on behalf of ALE
Total number of Forms 1095-C filed by and/or on behalf of ALE Member...
Enter the number if present.
Numbers only.
Leave the entry blank or blank the field if it has alpha characters or words.
Line 21-ALE Member of group-Yes
Is ALE Member a member of an Aggregated ALE group?... Yes box
Enter "X" if the "Yes" box is marked.
Line 21-ALE Member of group-No
Is ALE Member a member of an Aggregated ALE group?... No box
Enter "X" if the "No" box is marked.
Line 22-Offer Method
Line 22 box "A"
Enter "X" if the box is marked.
Line 22-98% Offer
Line 22 box "D"
Enter "X" if the box is marked.
OE/DV Screen Prompt
Page 2
Description
Page 2
Instructions
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 2Line 23-12 months-Essential Coverage-Yes
First check box in column (a) "Yes" row 23 Minimum Essential Coverage Offer Indicator labeled Yes
Enter an "X" if the "Yes" box is checked.
Line 23-12 months-Essential Coverage-No
Second check box in column (a) "No" row 23 Minimum Essential Coverage Offer Indicator labeled No
Enter an "X" if the "No" box is checked.
Line 23-12 months-Full Time count
Column (b) Full-Time Employee Count for ALE Member
Enter the number from line 23 column (b) if present.
Whole numbers or blank is valid.
Do not enter fractions, decimal points, or numbers to the right of a decimal point.
Do not round up or down if a fractional or decimal is entered by the filer.
Do not enter zeros: 0, 00, 00.00, or, 0.00 etc.
Line 23-12 months-Total Emp. Count
Column (c) Total Employee Count for ALE Member
Enter the number from line 23 column (c) if present.
Whole numbers or blank is valid.
Do not enter fractions, decimal points, or numbers to the right of a decimal point.
Do not round up or down if a fractional or decimal is entered by the filer.
Do not enter zeros: 0, 00, 00.00, or, 0.00 etc.
Line 23-12 months-Agg. Group Ind
Column (d) Aggregated Group Indicator
Enter an "X" if the box is checked.
Line 24-Jan-Essential Coverage-Yes
through
Line 35-Dec-Essential Coverage-Yes
First check box in column (a) "Yes" row 24 Minimum Essential Coverage Offer Indicator labeled Yes
Enter "X" if the "Yes" box is marked.
Line 24-Jan-Essential Coverage-No
through
Line 35-Dec-Essential Coverage-No
Second check box in column (a) "No" row 24 Minimum Essential Coverage Offer Indicator labeled No
Enter "X" if the "No" box is marked.
Note:
Instructions repeat for all entries on line 23, All 12 Months, (row 2) to line 35, Dec, (row 14).
Line 24-Jan-Full-Time count
through
Line 35-Dec-Full Time count
Column (b)Full-Time Employee Count for ALE Member
Enter the number from line 24 column (b) if present.
Line 24-Jan-Total Emp. Count
through
Line 35-Dec-Total Emp. Count
Column (c) Total Employee Count for ALE Member
Enter the number from line 24 column (c) if present.
Line 24-Jan-Agg. Group Ind
through
Line 35-Dec-Agg. Group Ind
Column (d) Aggregated Group Indicator
Enter an "X" if the box is checked.
OE/DV Screen Prompt
Page 3
Description
Page 3
Instructions
Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns - Page 3Line 36-Name
Name of Other ALE Members of Aggregated ALE Group
Enter the full name shown if present. Enter a space for any illegible characters. Do not leave two consecutive spaces.
Line 36-EIN
EIN of Other ALE Members of Aggregated ALE Group
Enter the EIN if present.
Enter a period for illegible characters.
If more than nine-digits enter the first nine-digits.
Line 37-65
-Name
Name of Other ALE Members of Aggregated ALE Group
Use instruction for Line 36-Name for any entries present for Line 37-65-Name.
Line 37-65
-EIN
EIN of Other ALE Members of Aggregated ALE Group
Repeat instruction for Line 36-EIN for any entries present for Line 37-65-EIN.
OE/DV Screen Prompt
Page 1
Description
Page 1
Instructions
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage - Page 1Tax Year
(located top right-hand of form)
The tax year is a must enter field entry.
Enter the tax year printed/present in the upper right-hand corner of the form.
Requires two consecutive matching and valid entries to leave the field.
Enter "00" when an invalid tax year is present, or the year does not match the transmittal.
Reminder:
Valid tax years: 2017, 2018, 2019 and 2020.
Then select "yes" when prompted to delete the return.
Note:
The system 1) recognizes the tax year present and 2) presents the year for site verification before releasing from the field.
VOID Box
VOID Box
Enter "X" if marked or if the document is blank.
Note:
All data on the form is invalid if the filer marks the void box, writes void on the form, marks through the entire form or the SCRIPS operator has voided the return due to duplication within the submission.
CORRECTED Box
CORRECTED Box
Enter "X" if marked.
Tax Year ≥ 2018
Line 1-Employee First Name
Employee first name
Enter the first name if present or you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in last/full name.
Tax Year ≥ 2018
Line 1-Employee Middle Initial
Employee middle initial
Enter the middle initial if present or you can determine it.
Tax Year ≥ 2018
Line 1-Employee Last/Full Name
Employee last name/full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Tax Year 2017
Line 1-Employee Name
Name of employee
Enter the full name shown.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Line 2-SSN
Social security number (SSN)
Enter the nine-digit SSN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Line 3-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Line 4-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Line 5-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Line 6-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Line 7-Employer Name
Name employer
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character. Do not leave two consecutive spaces.
If the name is missing and is not present press .
Line 8-EIN
Employer identification number
Enter the nine-digit EIN present.
If the EIN is missing or is more than or less than nine-digits press to perfect the EIN.
Line 9-Address
Street address
Enter the street address from the form.
If a foreign address, enter the address.
Note:
If the Address is incomplete or illegible press to perfect the data. See IRM 3.41.267.9 (10) for information.
Line 10-Contact Phone
Contact telephone number
Enter up to the first twelve numbers if present.
Is blank, 7, 10, or, 12 numerics.
Note:
Extensions optional.
Line 11-City
City or town
Enter the name of the city.
If a foreign address is present, enter the city.
Note:
If the City is incomplete or illegible press to perfect the data. See IRM 3.41.267.9 (10) for information.
Line 12-State/Province
State or province
Enter the two-character code for the state listed on the document.
If a foreign address, enter the province.
Note:
If the State is incomplete or illegible press to perfect the data. See IRM 3.41.267.9 (10) for information.
Line 13-Zip/Foreign Postal Code
Country and ZIP or foreign postal code
Enter the five-digit ZIP Code. If missing, press to bypass this field.
If a foreign address, enter the Country and/or foreign postal code.
Note:
If the ZIP is incomplete or illegible press to perfect the data. See IRM 3.41.267.9 (10) for information.
Tax Year ≥ 2020
Part II Employee’s Age
Employee’s Age on January 1
Enter the number present. A number 1 through 120 or blank is valid.
If no entry is present, or the entry is invalid or illegible blank the field.
Part II-Plan Month
Plan Start Month (Enter a two-digit number):
Enter the one or two-digit number present. 00 through 12 is valid. Enter 00 if no entry is present.
If month is written in (January through December) or an abbreviation for a month (Jan through Dec) enter the corresponding two-digit month.
Caution:
Scan the entire Plan Start Month area for an entry.
Line 14-All 12 months
Offer of Coverage (enter required code)
Enter the numeric alpha combination present on the document.
Tax Year 2020 valid combinations: "1A" through "1Z".
Tax Years 2019, 2018 and 2017 valid characters: "1A" through "1K"
If multiple codes appear enter the first code combination in the column transcribed.
Remove invalid combinations.
Example:
Delete invalid combinations such as "A1" and "11".
Line 14-Jan
through
Line 14-Dec
Offer of Coverage (enter required code)
Enter the numeric alpha combination present on the document.
Tax Year 2020 valid combinations: "1A" through "1Z".
Tax Years 2019, 2018 and 2017 valid characters: "1A" through "1K"
If multiple codes appear present enter the first code combination in the column transcribed.
Remove invalid combinations.
Example:
Delete invalid combinations such as "A1" and "11".
Note:
Instructions repeat for all entries on line 14, All 12 Months, (column 2) to Dec (column 14).
Line 15-All 12 months
Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage
Enter the dollar amount from line 15 column "All 12 Months" .
Enter the amount in dollars only.
Enter a single zero if 0 or 00 is present.
Blank the field if a negative figure or a negative 0 is present. Use the space bar to for a blank field.
Line 15-Jan
through
Line 15-Dec
Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage
Enter the dollar amount from line 15 column "Jan" .
Enter the amount in dollars only.
Enter a single zero if 0 or 00 is present.
Blank the field if a negative figure or a negative 0 is present. Use the space bar for a blank field.
Note:
Instructions repeat for all entries on line 15, All 12 Months, (column 2) to Dec (column 14).
Line 16-All 12 months
Applicable Section 4980H Safe Harbor (enter code, if applicable)
Enter the numeric alpha combination present on the document.
Valid combinations: "2A" , "2B" , "2C" , "2D" , "2E" , "2F" , "2G" , "2H" , "2I" ,and "2J".
If multiple codes appear enter the first code combination in the column transcribed.
Remove invalid combinations.
Line 16-Jan
through
Line 16-Dec
Applicable Section 4980H Safe Harbor (enter code, if applicable)
Enter the numeric alpha combination present on the document.
Valid combinations: "2A" , "2B" , "2C" , "2D" , "2E" , "2F" , "2G" , "2H" , "2I" ,and "2J".
If multiple codes appear enter the first code combination in the column transcribed.
Remove invalid combinations.
Note:
Instructions repeat for all entries on line 16, All 12 Months, (column 2) to Dec (column 14).
Tax Year ≥ 2020
Line 17 All 12 Months
ZIP Code
Enter the five-digit ZIP Code.
If blank, incomplete, or illegible press to bypass this field.
If too long enter the first five-digits present.
Tax Year ≥ 2020
Line 17-Jan
through
Line 17-Dec
ZIP Code
Enter the five-digit ZIP Code.
If blank, incomplete, or illegible press to bypass this field.
If too long enter the first five-digits present.
Tax Year 2019, 2018, 2017
Part III-Employer-provided self-insure coverage
If Employer provided self-insured coverage, check the box and enter the information for each covered individual.
Enter "X" if marked.
Tax Year 2019 and 2018
Line 17(a)-Covered Ind.
through
Line 22(a)-Covered Ind.First Name
Covered individual(s) first name
Enter the first name if present or if you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in last/full name.
Tax Year 2019 and 2018
Line 17(a)-Covered Ind.
through
Line 22(a)-Covered Ind.Middle Initial
Covered individual(s) middle initial
Enter the middle initial if present or if you can determine it.
Tax Year 2019, 2018
Line 17(a)-Covered Ind.
through
Line 22(a)-Covered Ind.
Covered individual(s) last name/full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Tax Year 2017
Line 17(a)-Covered Ind.
through
Line 22(a)-Covered Ind.
Name of covered individual(s)
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Note:
Instructions repeat for all entries for each covered individual listed on line 17 (columns a, b, c, d, and e) through line 22 (columns a, b, c, d, and e).
Tax Year 2019, 2018, 2017Line 17(b)-SSN or other TIN
through
Line 22(b)-SSN or other TIN
SSN
Enter the nine-digit SSN or TIN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Exception:
If name matches line 1 and the SSN is present on line 2 mirror the entry for line 2.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Tax Year 2019, 2018, 2017
Line 17(c)-DoB
through
Line 22(c)-DoB
DOB (If SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD, or YYYY appear missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Tax Year 2019, 2018, 2017
Line 17(d)-12 Months
through
Line 22(d)-Dec
Covered all 12 months
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Tax Year 2019, 2018, 2017
Line 17(e)-Jan
through
Line 17(e)-Dec
Months of coverage Jan through Dec
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
OE/DV Screen Prompt
Page 3
Tax Year 2020
Description
Page 3
Instructions
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage - Page 3
Tax Year 2020Part III-Employer-provided self-insure coverage
If Employer provided self-insured coverage, check the box and enter the information for each covered individual.
Enter "X" if marked.
Line 18(a)-Covered Ind.
through
Line 30(a)-Covered Ind.First Name
Covered individual(s) first name
Enter the first name if present or if you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in last/full name.
Line 18(a)-Covered Ind.
through
Line 30(a)-Covered Ind.Middle Initial
Covered individual(s) middle initial
Enter the middle initial if present or if you can determine it.
Line 18(a)-Covered Ind.
through
Line 30(a)-Covered Ind.
Covered individual(s) last name/full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Line 18(b)-SSN or other TIN
through
Line 30(b)-SSN or other TIN
SSN
Enter the nine-digit SSN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Exception:
If name matches line 1 and the SSN is present on line 2 mirror the entry for line 2.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Line 18(c)-DoB
through
Line 30(c)-DoB
DOB (If SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
If any of one of MM, DD, or YYYY is missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Line 18(d)-12 Months
through
Line 30(d)-12 Months
Covered all 12 months
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Line 18(e)-Jan
through
Line 30(e)-Dec
Months of coverage Jan through Dec
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
OE/DV Screen Prompt
Page 3
Tax Year 2019, 2018, 2017
Description
Page 3
Instructions
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage - Page 3
Tax Year 2019, 2018, 2017SSN
Social security number (SSN)
Enter the nine-digit SSN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Tax Year 2019 2018
Line 23(a)-Covered Ind.
through
Line 34(a)-Covered Ind.First Name
Covered individual(s) first name
Enter the first name if present or you can determine it.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in last/full name.
Tax Year 2019 2018
Line 23(a)-Covered Ind.
through
Line34(a)-Covered Ind.Middle Initial
Covered individual(s) middle initial
Enter the middle initial if present or if you can determine it.
Tax Year 2019 2018
Line 23(a)-Covered Ind.
through
Line 34(a)-Covered Ind.
Covered individual(s) last name/full name
Enter the last name.
If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
If it is not possible to determine first, middle initial, and last name place the entire name in this field.
Enter suffixes after the last name entry.
Note:
Instructions repeat for all entries for each covered individual listed on line 17 (columns a, b, c, d, and e) through line 22 (columns a, b, c, d, and e).
Tax Year 2017
Line 23(a)-Covered Ind.
through
Line 34(a)-Covered Ind.
Name of covered individual(s)
Enter the full name shown. If any character in the name is illegible enter a space for the illegible character.
Do not leave two consecutive spaces.
Note:
Instructions repeat for all entries for each covered individual listed on line 17 (columns a, b, c, d, and e) through line 22 (columns a, b, c, d, and e).
Line 23(b)-SSN or other TIN
through
Line 34(b)-SSN or other TIN
SSN
Enter the nine-digit SSN or TIN present.
If the SSN is more than nine-digits enter the first nine-digits.
If any digit is illegible or missing enter a period for the illegible or missing digit.
Exception:
If more than 50 percent of the SSNs in the UW appear redacted suspend under Supervisor Request.
If blank, single repeating digit such as 111111111, 222222222, etc., or sequential 123456789 do not make an entry. Press .
Exception:
If 50 percent or more of the SSNs in the UW meet the conditions above suspend under Supervisor Request.
Caution:
Do not enter any data present in columns (b, c, d, or e) if there is no corresponding name present in column (a).
Line 23(c)-DoB
through
Line 34(c)-DoB
DOB (If SSN is not available)
Enter the date of birth if present in MMDDYYYY format if a complete date is present.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Caution:
If any of one of MM, DD or YYYY is missing the remaining combination "is not" a DoB. Do not enter partial data in the field.
Line 23(d)-12 Months
through
Line 34(d)-Dec
Covered all 12 months
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Line 23(e)-Jan
through
Line 34(e)-Dec
Months of coverage Jan through Dec
Enter "X" if marked.
Caution:
Do not enter any data present in columns (b, c, d, or, e) if there is no corresponding name present in column (a).
Note:
Instructions repeat for all entries for each covered individual listed on line 23 (columns a, b, c, d, and e) through line 34 (columns a, b, c, d, and e).
Exhibit 3.41.267-7
Valid Characters
OE/DV Screen Prompt
Valid CharactersFirst name
Tax Year ≥ 2018
Alphas (A through Z)
Numerics (0 through 9)
Hyphen (-)
Blank/Space
Note:
Never enter two consecutive spaces.
Maximum 35 characters
Caution:
Do not enter other characters even if present on the form.
Middle Initial
Tax Year ≥ 2018
Alphas (A through Z)
Maximum 1 character
Last Name/Full Name
Tax Year ≥ 2018
Name Line
Tax Year 2017
Alphas (A through Z)
Numerics (0 through 9)
Hyphen (-)
Blank/Space
Note:
Never enter two consecutive spaces.
Ampersand (&)
Maximum 35 characters
Caution:
Do not enter other characters even if present on the form.
Address Line
Alphas (A through Z)
Numerics (0 through 9)
Hyphen (-)
If blank, enter Z
Slash (/)
Asterisk (*) only valid in first position for PO Box
Space
Note:
Never enter two consecutive spaces.
Maximum 35 characters
Caution:
Do not enter other characters even if present on the form.
City Line
Alphas (A through Z)
If blank, enter ZZZ
Space
Note:
Space for all special characters in the city/state line with except for an apostrophe. Never enter two consecutive spaces and leave no space for the apostrophe.
Maximum 25 characters
Caution:
Do not enter other characters even if present on the form.
State Line
Alphas (A through Z)
Blank/Space
Maximum 2 characters
Note:
Domestic addresses take precedent over foreign addresses in the presence of both.
Province Line
Alphas (A through Z)
Blank/Space
Maximum 17 characters
Note:
Domestic addresses take precedent over foreign addresses in the presence of both.
ZIP Code
Numerics (0-9)
Space
Maximum five or nine numerics
Reminder:
The Zone Improvement Plan (ZIP) Code is consistent with the ZIP Code tables listed in Exhibit 3.41.267-2, Exhibit 3.41.267-3, Exhibit 3.41.267-4, and Exhibit 3.41.267-5.
Country/Foreign postal code
Alphas (A through Z)
Numerics (0-9)
Maximum 35 characters
Reminder:
The ZIP Code is consistent with the ZIP Code tables list in Exhibit 3.41.267-2, Exhibit 3.41.267-3, Exhibit 3.41.267-4, and Exhibit 3.41.267-5.
Contact Phone
Seven, ten or twelve-digits (numbers).
Numeric (0-9)
Space
Date of Birth (DoB, DOB)
Numeric (0-9)
Format MMDDYYYY
Blank/Space
Checkboxes
Alpha "X"
Blank
Exhibit 3.41.267-8
Unit Production Card (UPC) Inputs for Batch/Block Tracking System (BBTS)
SCRIPS Report Number
or
Source
Report Name
Identifier
Applicable Program Number
BBTS Receipts
(Yes or No)
BBTS Production
(Yes or No)IPS0083
Workstation Operator Statistics Program and Function Summary Report
460-44320
470-44320
480-44320
Yes
Yes
Receipt and Control release to SCRIPS
Local Reports
500-44320
Yes
No
IPS01119
Run Balance Report
Total Records Processed
500-44320
No
Yes
IPS06440
Throughput Statistics Report
Total Documents for all scandrivers
minus
Total records deleted on IPS01119
450-44320
Yes
No
IPS01119
Total Records Processed
Run Balance Report
Data Records Output
450-44320
No
Yes
6550
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