A Control Files and Sample Forms

This appendix contains the following topics:

A.1 Control Files

The system uses each of the following files in the AIR processing steps in this guide.

A.1.1 F08116 - ALE ID to Home Company X-Ref

This file allows multiple home companies to be grouped together under the same Applicable Large Employer (ALE) ID, effectively creating an ALE.

A.1.2 F081161 - Employee ACA Eligibility File

This file provides information on an employee's full-time or part-time status for ACA reporting, and also whether the employee has been in a Limited Non-Assessment Period.

A.1.3 F08117 - Offer and Coverage Setup

This file provides the code values for ACA Form 1095-C lines 14, 15, and 16.

A.1.4 F08118 - Periods of Employment

This file is used to determine employment dates, especially when there are multiple starts and terminations for an employee.

A.1.5 F08118DZ - ACA Periods of Employment - Z File

This is the detail import file for Periods of Employment.

A.1.6 F08118HZ - ACA Periods of Employment - Header Z File

This is the header import file for Periods of Employment.

A.1.7 F08119 - 1095-C Offer and Coverage Information

This file contains the final information that is used to produce the Form 1095-C for an ALE Member, Employee, or Reporting Year.

A.1.8 F08119Z - ACA Offer and Coverage Revisions - Batch Z

This is the import file for ACA Offer and Coverage.

A.1.9 F08120 - 1095-C Covered Individuals

This file contains information for Part III of the Form 1095-C (Covered Individuals).

A.1.10 F08120Z - ACA Covered Individuals - Batch Z File

This is the import file for ACA Covered Individuals.

A.1.11 F08121 - 1094-C ALE Member Information

This file contains information for Part I and Part II of the Form 1094-C.

A.1.12 F08122 - 1094C ALE Member Information - Monthly

This file contains information for Part III of the Form 1094-C.

A.1.13 F08123 - 1094C Other Aggregated ALE Group Members

This file contains information for Part IV of the Form 1094-C.

A.1.14 F08124 - Hours Worked by Month

This file accumulates the hours an employee worked during each month of the reporting year.

A.1.15 F08210 - ACA Information Returns Control

This file contains the control parameters for information common to each AIR ID.

A.1.16 F08211 - ACA Transmission

This file contains information about ACA Transmissions.

A.1.17 F08212 - ACA Submission

This file contains information about ACA Submissions.

A.1.18 F08213 - ACA Manifest Information

The file contains information used to create ACA Manifest XML files.

A.1.19 F08214 - Transmission Replacement Cross-Reference

This file is a cross-reference between replacement transmissions and the original transmission being replaced.

A.2 Sample Form 1095-C

This form is provided for informational purposes only. Do not reproduce this form for filing.

This is an example of the Form 1095-C:

Figure A-1 Sample of Employer-Provided Health Insurance Offer and Coverage (Form 1095-C)

Surrounding text describes Figure A-1 .