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[PDF File]RECOMMENDATION FOR AWARD - United States Army
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[PDF File]Health Benefits Election Form
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Health Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 Previous edition is not usable Revised November 2015 . ... Enter email address, if applicable, for this family member. Item 24. Enter preferred telephone number, if applicable, for this
[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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Don't staple Form 941-V or your payment to Form 941 (or to each other). • Detach Form 941-V and send it with your payment and Form 941 to the address in the Instructions for Form 941. Note: You must also complete the entity information above Part 1 on Form 941. Detach Here and Mail With Your Payment and Form 941. Form. 941-V
[PDF File]Form 149 - Sales and Use Tax Exemption Certificate
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149 Sales and Use Tax Exemption Certificate. Form 149 (Revised 11-2018) Select the appropriate box for the type of exemption to be claimed and complete any additional information requested. • Purchases of Tangible Personal Property for resale: Retailers that are purchasing tangible personal property for resale purposes are exempt ...
[PDF File]Request for Social Security Earnings Information
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Form . SSA-7050-F4 (03-2019) Page 2 of 4. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . 1. Provide your name as it appears on your most recent Social Security card or the name of the individual whose
[PDF File]Form W-9 (Rev. October 2018)
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The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
[PDF File]REASSIGNMENT OF MEDICARE BENEFITS CMS-855R
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terminate a reassignment of Medicare benefits after enrollment in the Medicare program or make a change in their reassignment of Medicare benefit information using either: • The Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or • The paper CMS-855R application. Be sure you are using the most current version.
[PDF File]Request for Leave or Approved Absence
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requested for the purpose(s) indicated. I understand that I must comply with my employing agency's procedures for requesting leave/ approved absence (and provide additional documentation, including medical certification, if required) and that falsification on this form may be grounds for disciplinary action, including removal.
Standard Form 1199A, Direct Deposit Sign-up Form
authorize my payment to be sent to the financial institution named below to be deposited to the designated account. JOINT ACCOUNT HOLDERS’ CERTIFICATION (optional) I certify that I have read and understood the back of this form, including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS. SIGNATURE DATE
[PDF File]Practitioner and Provider Compliant and Appeal Request
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Contact Email Address . To help Aetna review and respond to your request, please provide the following information. (This information may be found on correspondence from Aetna.) You may use this form to appeal multiple dates of service for the same member. Claim ID Number (s) Reference Number/Authorization Number . Service Date(s)
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