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Click
to select the Section 4980H safe harbor employer relief code that applied to the employee.
If the same safe harbor code applied to the employee for all 12 calendar months, select the applicable code in the All drop-down field.
If different safe harbor codes applied to the employee throughout the 12 calendar months, select the applicable codes in the respective month (Jan-Dec) fields.
Note: It is possible that more than one circumstance applied to the same employee in the same month; however, only one code can be selected per month.
1095-C Forms report notes:
If the Safe Harbor (line 16) code in all individual month (Jan-Dec) fields matches the code in the All field, then that code is printed in the All field and the individual month fields are blank.
If all individual month (Jan-Dec) fields are blank but the All field is populated, then that Safe Harbor code is printed in the All field and the individual month (Jan-Dec) fields remain blank.
If the Safe Harbor code varies in the individual month (Jan-Dec) fields, then the All field is blank and the codes in the individual month (Jan-Dec) fields are printed.
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