LINE 16 REVIEW
Year / employer / employee / month:
Employment days and supporting record:
Full-time determination / method / source:
Enrollment dates:
Limited non-assessment period review:
Multiemployer or post-employment arrangement:
Safe-harbor method / calculation reference:

DECISION
Candidate codes:
Applicable instruction and ordering rule:
Selected code or intentional blank:
Decisive fact / rejected alternative / reason:
Reviewer / actual decision date:

CHECKS
[ ] Termination month distinguished from later non-employment
[ ] Enrollment dates reviewed, not just a flag
[ ] Waiver not assigned a nonexistent waiver code
[ ] Special arrangements and ordering checked
[ ] Safe-harbor source uses applicable-year inputs
[ ] Related batch records reviewed after a shared-rule finding
Output version / unresolved fact / owner: