1095-B PREPARER FIELD REVIEW
Provider / reporting year / statement reference / draft version:
B-series scope determination:
PART I
Responsible individual / covered or not covered / identity treatment:
Coverage-origin code / supporting arrangement:
PART II
Applicable or intentionally blank / instruction basis:
Employer source, if applicable:
PART III
Provider identity matches approved record:
Line 18 contact reaches the responsible service process:
PART IV
Person alias | identity treatment | approved months | draft months | continuation row | finding
FICTIONAL PH-24
Taylor 12 + spouse 12 + child Aug-Dec 5 = 29 person-months.
Child all-year error adds seven incorrect month marks.
RELEASE
Changed fields / unaffected fields rechecked:
Reviewed version / actual reviewer / decision:
Filing owner / furnishing owner / later inquiry reference: