This file is used for uploading code data (lines 14, 15, 16) for the 1095c forms to be generated in the Accord System.
Valid formats
.csv.xls.xlsx
| Field Position | Field Name | Required | Valid Values | Example Value | Note |
|---|---|---|---|---|---|
| 1 | void | N | Y, N, blank | N | |
| 2 | corrected | N | Y, N, blank | Y | |
| 3 | first_name | Y | John | ||
| 4 | middle_name | N | M | ||
| 5 | last_name | Y | Doe | ||
| 6 | ssn | Y | 123456789 | Social Security Number (no dashes) of employee | |
| 7 | address_1 | Y | 123 Main Street | ||
| 8 | address_2 | N | Apt. 123 | If the employee has an apartment number or unit number, please provide it in this field. | |
| 9 | city_or_town | Y | Atlanta | ||
| 10 | state_or_province | Y | GA | ||
| 11 | country_and_zip | Y | 30329 | Include country if non-US | |
| 12 | N | test@accord-aca.com | |||
| 13 | all_code | N | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Use if all codes for the 12 months are the same. You can only use this field if specific month codes are blank. |
| 14 | all_employee_share | N | 83.33 | Use if employee share amounts for the 12 months are the same. You can only use this field if specific amounts are blank. | |
| 15 | all_safe_harbor | N | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Use if all codes for 12 months are the same. You can only use this field if specific month codes are blank. |
| 16 | jan_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 17 | jan_employee_share | Y | 83.33 | Line 15 | |
| 18 | jan_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 19 | feb_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 20 | feb_employee_share | Y | 83.33 | Line 15 | |
| 21 | feb_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 22 | mar_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 23 | mar_employee_share | Y | 83.33 | Line 15 | |
| 24 | mar_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 25 | apr_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 26 | apr_employee_share | Y | 83.33 | Line 15 | |
| 27 | apr_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 28 | may_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 29 | may_employee_share | Y | 83.33 | Line 15 | |
| 30 | may_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 31 | jun_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 32 | jun_employee_share | Y | 83.33 | Line 15 | |
| 33 | jun_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 34 | jul_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 35 | jul_employee_share | Y | 83.33 | Line 15 | |
| 36 | jul_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 37 | aug_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 38 | aug_employee_share | Y | 83.33 | Line 15 | |
| 39 | aug_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 40 | sep_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 41 | sep_employee_share | Y | 83.33 | Line 15 | |
| 42 | sep_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 43 | oct_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 44 | oct_employee_share | Y | 83.33 | Line 15 | |
| 45 | oct_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 46 | nov_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 47 | nov_employee_share | Y | 83.33 | Line 15 | |
| 48 | nov_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 49 | dec_code | Y | 1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1O, 1P, 1Q, 1R, 1S, 1T, 1U, 1V, 1W, 1X, 1Y, 1Z | 1E | Line 14 |
| 50 | dec_employee_share | Y | 83.33 | Line 15 | |
| 51 | dec_safe_harbor | Y | 2A, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I | 2C | Line 16 |
| 52 | custom_1 | N | my_custom_value | ||
| 53 | custom_2 | N | |||
| 54 | custom_3 | N | |||
| 55 | custom_4 | N | |||
| 56 | custom_5 | N | |||
| 57 | custom_6 | N | |||
| 58 | custom_7 | N | |||
| 59 | custom_8 | N | |||
| 60 | custom_9 | N | |||
| 61 | custom_10 | N |