Applicable large employer (ALE) details


Part I - Applicable Large Employer Member (Employer)


Lines 7-13 contain information regarding the ALE reporting offered coverage.

Line 7: Name of Employer
In line 7, begin with the complete name of employer.

Line 8: Employer Identification Number of Employer
In Line 8, enter the ALE's nine-digit EIN (employer identification number). You cannot substitute a SSN for an EIN. If you need to apply for one, you can do so online at www.irs.gov or by mailing or faxing Form SS-4 to the IRS.

Line 9: Street address (including room or suite no.)
Line 10: Contact telephone number
Line 11: City or town
Line 12: State or province
Line 13: Country and ZIP or foreign postal code
From line 9 to 13, enter the complete address of the ALE offering coverage, including a room or suite number, if applicable.