This refers to the employee’s full legal name and is entered in columns A (Legal First Name), B (Middle Initial, if available), C (Legal Last Name), and D (Suffix, if applicable).

— Daniel Keys Moran
Get Started NowBorrowing from the quote above, it’s also true that you cannot have reporting without data. In our best effort to reduce challenges employers face when gathering data, we’ve implemented a method that requires minimal employee information. Use the data template as a model to extract the necessary content required from a payroll census report and medical plan enrollment report. Follow the steps in the prep document to help with benefit plan information.
Download Data Template Download Prep DocumentThis refers to the employee’s full legal name and is entered in columns A (Legal First Name), B (Middle Initial, if available), C (Legal Last Name), and D (Suffix, if applicable).
Please list the employee’s SSN as it appears on their Social Security Card and properly format any leading zeros for accuracy. This entry appears on column E of the data template.
This refers to the employee’s or dependent of an employee’s full legal name and is entered in columns A (Legal First Name), B (Middle Initial, if available), C (Legal Last Name), and D (Suffix, if applicable).
Please list the employee or dependent SSN as it appears on their Social Security Card and properly format any leading zeros for accuracy. This entry appears on column E of the data template.
Enter the start date of medical plan coverage listed as MM/DD/YYYY for the member. This entry appears on column M of the data template.
Enter the end date of medical plan coverage listed as MM/DD/YYYY for the member. This entry appears on column N of the data template.
Please list one of the following that describes the plan member: Employee, Dependent of Employee, Non-Employee Enrolled or Dependent of a Non-Employee. This entry appears on column O of the data template.
Enter the SSN of the Employee or Non-Employee Enrolled who’s coverage applies to this member. This allows our system to complete Part III of Form 1095C for self insured employers. This entry appears on column P of the data template.