FORM 1095-C File Schema

Sample File = Schema\2021\TEXT\T1095C.txt

String fields are displayed within quotations

CRLF=Carriage Return Line Feed (Hex 0D0A)


"Import ID"

"Control number"

"Employee ID"

"First name"

"Middle initial"

"Last name"


"Name control"

"Social Security Number"

"Street address line 1"

"Street address line 2"



"Zip code"

"Zip code extension"

"USPS Delivery Point"

"Foreign address indicator" ¹

"Foreign city"

"Foreign state or province"

"Foreign postal code"

"Foreign country code (2 characters)"

Employee's Age on Jan 1

Plan Start Month

Employer provided self-insured coverage¹

12 months Offer of Coverage code

12 months Employee share

12 months Safe Harbor code

12 months Applicable Zip code

January Offer of Coverage code

January Employee share

January Safe Harbor code

January Applicable Zip code

February Offer of Coverage code

February Employee share

February Safe Harbor code

February Applicable Zip code

March Offer of Coverage code

March Employee share

March Safe Harbor code

March Applicable Zip code

April Offer of Coverage code

April Employee share

April Safe Harbor code

April Applicable Zip code

May Offer of Coverage code

May Employee share

May Safe Harbor code

May Applicable Zip code

June Offer of Coverage code

June Employee share

June Safe Harbor code

June Applicable Zip code

July Offer of Coverage code

July Employee share

July Safe Harbor code

July Applicable Zip code

August Offer of Coverage code

August Employee share

August Safe Harbor code

August Applicable Zip code

September Offer of Coverage code

September Employee share

September Safe Harbor code

September Applicable Zip code

October Offer of Coverage code

October Employee share

October Safe Harbor code

October Applicable Zip code

November Offer of Coverage code

November Employee share

November Safe Harbor code

November Applicable Zip code

December Offer of Coverage code

December Employee share

December Safe Harbor code

December Applicable Zip code

"Do not print indicator" ¹

"E-Mail address"

"Client ID"



¹ "X" if applicable, otherwise, enter a null string ""