1095-B PART IV FIELD REVIEW
Provider / year / statement reference / source version / draft version:
Responsible individual / covered or uncovered / reviewed relationship:
PERSON ROW
Person alias | approved name | TIN or conditional DOB treatment | expected months | generated months | main/continuation location | finding
IRS filing identity presentation checked:
Furnished-copy truncation checked separately:
FICTIONAL BE-52
Ellis Part I only; child A twelve months; child B May-Dec eight months.
Two covered people; 12 + 8 = 20 person-months.
CONTINUATION CHECK
Seven-person test: six main rows plus one continuation row equals seven people on one return.
Actual output inspected / legibility / parent association / all rows present:
RELEASE
Changed person/field / source decision / wider mapping scope:
Unchanged rows rechecked / revised version / actual reviewer:
Previously filed or furnished / correction intake reference:
Filing and furnishing owners: