ACA Reprint Request

  • This form is to order a duplicate IRS Form 1095-C “Employer-Provided Health Insurance Offer and Coverage.”
  • To request a reprint for the most recent year, do not submit your request until after March 1 to allow time for postal delivery of the original form.
  • Requests received prior to March 1 are not processed until after March 1. Requests are processed in the order received.
  • Requests will be delivered by our secure email system called Virtru.

Contact Us

About This Service

Have a question for our agency? We provide an easy way to reach out to us online through our website. Simply by clicking on the contact us page, you can submit a form to ask us any questions you may have for our agency or the services that we provide. Please provide us a detailed message with all of your contact information so that we may get back to you in a timely manner.

Requirements of the Customer

When you submit your form, please provide us with the following info: