FDX Data Structure as JSON

{
  "tax1095B" : {
    "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,
      "coveredMonths" : [ "JAN" ]
    } ]
  }
}

FDX / Data Structures / Tax1095B

Form 1095-B, Health Coverage

Extends and inherits all fields from Tax

Tax1095B Properties

#	Id	Type	Description
1	responsibleName	IndividualName	Box 1, Name of responsible individual
2	responsibleTin	string	Box 2, Social security number (SSN or other TIN)
3	responsibleDateOfBirth	DateString	Box 3, Date of birth (if SSN or other TIN is not available)
4	responsibleAddress	Address	Boxes 4-7, Address of responsible individual
5	originOfHealthCoverageCode	string	Box 8, Enter letter identifying Origin of the Health Coverage
6	employerNameAddress	NameAddress	Boxes 10, 12-15, Employer name and address
7	employerId	string	Box 11, Employer identification number (EIN) (deprecated for rename to employerTin, removing in FDX v5.0)
8	employerTin	string	Box 11, Employer identification number (EIN)
9	issuerNameAddressPhone	NameAddressPhone	Boxes 16, 18-22, Issuer name, address, and phone (deprecated for rename to issuerNameAddress, removing in FDX v5.0)
10	issuerNameAddress	NameAddressPhone	Boxes 16, 18-22, Issuer name, address, and phone
11	issuerId	string	Box 17, Employer identification number (EIN) (deprecated for rename to issuerTin, removing in FDX v5.0)
12	issuerTin	string	Box 17, Employer identification number (EIN)
13	coveredIndividuals	Array of HealthInsuranceCoveredIndividual	Boxes 23+, Covered Individuals

Tax1095B Usage:

TaxData tax1095B

Example Form JSON

{
  "tax1095B" : {
    "taxYear" : 2020,
    "taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-B",
    "taxFormDate" : "2021-02-01",
    "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",
      "coveredAt12Months" : 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",
      "coveredAt12Months" : true,
      "coveredMonths" : [ "JAN", "FEB", "MAR", "APR", "MAY", "JUN", "JUL", "AUG", "SEP", "OCT", "NOV", "DEC" ]
    } ]
  }
}

Tax Documents

Tax1095B

FDX Data Structure as JSON

FDX / Data Structures / Tax1095B

Form 1095-B, Health Coverage

Extends and inherits all fields from Tax

Tax1095B Properties

Tax1095B Usage:

Example Form JSON

Example Form JSON as QR Code