Tax Documents

 

Tax1095B

 

FDX Data Structure as JSON
{
  "taxYear" : 0,
  "corrected" : true,
  "accountId" : "",
  "taxFormId" : "",
  "taxFormDate" : "2020-07-01",
  "description" : "string",
  "additionalInformation" : "string",
  "taxFormType" : "BusinessIncomeStatement",
  "attributes" : [ {
    "name" : "string",
    "value" : "string",
    "boxNumber" : "string",
    "code" : "string"
  } ],
  "error" : {
    "code" : "string",
    "message" : "string"
  },
  "responsibleName" : {
    "first" : "string",
    "middle" : "string",
    "last" : "string",
    "suffix" : "string"
  },
  "responsibleTin" : "string",
  "responsibleDateOfBirth" : "2020-07-01",
  "responsibleAddress" : {
    "line1" : "String64",
    "line2" : "String64",
    "line3" : "String64",
    "city" : "String64",
    "state" : "String64",
    "postalCode" : "string",
    "country" : "AD"
  },
  "originOfHealthCoverageCode" : "string",
  "employerNameAddress" : {
    "line1" : "String64",
    "line2" : "String64",
    "line3" : "String64",
    "city" : "String64",
    "state" : "String64",
    "postalCode" : "string",
    "country" : "AD",
    "name1" : "String64",
    "name2" : "String64"
  },
  "employerId" : "string",
  "employerTin" : "string",
  "issuerNameAddressPhone" : {
    "line1" : "String64",
    "line2" : "String64",
    "line3" : "String64",
    "city" : "String64",
    "state" : "String64",
    "postalCode" : "string",
    "country" : "AD",
    "name1" : "String64",
    "name2" : "String64",
    "phone" : {
      "type" : "HOME",
      "country" : "string",
      "number" : "string",
      "extension" : "string"
    }
  },
  "issuerNameAddress" : {
    "line1" : "String64",
    "line2" : "String64",
    "line3" : "String64",
    "city" : "String64",
    "state" : "String64",
    "postalCode" : "string",
    "country" : "AD",
    "name1" : "String64",
    "name2" : "String64",
    "phone" : {
      "type" : "HOME",
      "country" : "string",
      "number" : "string",
      "extension" : "string"
    }
  },
  "issuerId" : "string",
  "issuerTin" : "string",
  "coveredIndividuals" : [ {
    "name" : {
      "first" : "string",
      "middle" : "string",
      "last" : "string",
      "suffix" : "string"
    },
    "tin" : "string",
    "dateOfBirth" : "2020-07-01",
    "coveredAt12Months" : true,
    "coveredAll12Months" : true,
    "coveredMonths" : [ "JAN" ]
  } ]
}
FDX / Data Structures / Tax1095B
Form 1095-B, Health Coverage
Extends and inherits all fields from Tax  
Tax1095B Properties
#IdTypeDescription
1responsibleNameIndividualNameBox 1, Name of responsible individual
2responsibleTinstringBox 2, Social security number (SSN or other TIN)
3responsibleDateOfBirthDateStringBox 3, Date of birth (if SSN or other TIN is not available)
4responsibleAddressAddressBoxes 4-7, Address of responsible individual
5originOfHealthCoverageCodestringBox 8, Enter letter identifying Origin of the Health Coverage
6employerNameAddressNameAddressBoxes 10, 12-15, Employer name and address
7employerIdstringBox 11, Employer identification number (EIN) (deprecated for rename to employerTin, removing in FDX v5.0)
8employerTinstringBox 11, Employer identification number (EIN)
9issuerNameAddressPhoneNameAddressPhoneBoxes 16, 18-22, Issuer name, address, and phone (deprecated for rename to issuerNameAddress, removing in FDX v5.0)
10issuerNameAddressNameAddressPhoneBoxes 16, 18-22, Issuer name, address, and phone
11issuerIdstringBox 17, Employer identification number (EIN) (deprecated for rename to issuerTin, removing in FDX v5.0)
12issuerTinstringBox 17, Employer identification number (EIN)
13coveredIndividualsArray of HealthInsuranceCoveredIndividualBoxes 23+, Covered Individuals
Tax1095B Usage:
Example Form JSON

Download

{
  "tax1095B" : {
    "taxYear" : 2020,
    "taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-B",
    "taxFormDate" : "2021-03-30",
    "additionalInformation" : "FDX v4.6",
    "taxFormType" : "Tax1095B",
    "responsibleName" : {
      "first" : "Kris",
      "middle" : "Q",
      "last" : "Public"
    },
    "responsibleTin" : "xxx-xx-1234",
    "responsibleDateOfBirth" : "1995-03-03",
    "responsibleAddress" : {
      "line1" : "1 Main St",
      "city" : "Melrose",
      "state" : "NY",
      "postalCode" : "12121",
      "country" : "US"
    },
    "originOfHealthCoverageCode" : "B",
    "employerNameAddress" : {
      "line1" : "12020 Sunrise Valley Dr",
      "line2" : "Suite 230",
      "city" : "Reston",
      "state" : "VA",
      "postalCode" : "20191",
      "country" : "US",
      "name1" : "Financial Data Exchange"
    },
    "employerTin" : "12-3456789",
    "issuerNameAddress" : {
      "line1" : "1718-1/2 Oak Blvd",
      "city" : "Austin",
      "state" : "TX",
      "postalCode" : "78735",
      "country" : "US",
      "name1" : "American People Health",
      "phone" : {
        "number" : "8885551212"
      }
    },
    "issuerTin" : "99-0011223",
    "coveredIndividuals" : [ {
      "name" : {
        "first" : "Kris",
        "middle" : "Q",
        "last" : "Public"
      },
      "tin" : "xxx-xx-1234",
      "dateOfBirth" : "1995-03-13",
      "coveredAll12Months" : true,
      "coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
    }, {
      "name" : {
        "first" : "Tracy",
        "middle" : "R",
        "last" : "Public"
      },
      "tin" : "xxx-xx-4321",
      "dateOfBirth" : "1995-04-13",
      "coveredAll12Months" : true,
      "coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
    } ]
  }
}
Example Form JSON as QR Code

Download

 

 

Example Form JSON for QR Code Purposes

Download

© Copyright 2021. All Rights Reserved.