I have no health insurance
[PDF File]8821 Tax Information Authorization OMB No. 1545-1165
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administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute this form with respect to the tax matters and tax periods shown on line 3 above. IF NOT COMPLETE, SIGNED, AND DATED, THIS TAX INFORMATION AUTHORIZATION WILL BE RETURNED.
[PDF File]Patient Health Questionnaire (PHQ-9)
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PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day (use " ü " to indicate your answer) 1. Little interest or pleasure in doing things 0 1 2 3
[PDF File]Request for Leave or Approved Absence
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a serious health condition may be required by your agency. I hereby invoke my entitlement to Family and Medical Leave for: Restored Annual Leave Advanced Annual Leave: ... to Federal Life Insurance or Health Benefits carriers regarding a claim; to a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or ...
[PDF File]Department of Taxation and Finance Instructions for Form ...
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and have the same modification as a partner for income from a partnership. You would enter 102 and the applicable amounts under Schedule A, Part 1 as an individual, and Schedule A, Part 2 as a partner. If you have more than seven entries in any part, submit a separate Form IT-225 listing the additional addition or
[PDF File]DR 2395 (04/02/15) COLORADO DEPARTMENT OF REVENUE ...
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Motor vehicle insurance or operator's coverage is compulsory in the State of Colorado. Proof of insurance is required prior to issuance of a registration. Non-compli-ance with this requirement is a misdemeanor traffic offense. Pursuant to 42-4-1409, C.R.S., the penalties for failure to have motor vehicle insurance coverage is a
[PDF File]Thrift Savings Plan
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Check to make sure of the following: You provide your name and account number on each page that you submit to the TSP. You print legibly. You sign all pages you complete (including any extra pages you add) on the same date. You have the same witness sign and date all pages—including any extra pages—after you sign and date the form. The witness cannot be named as a
[PDF File]Health Benefits Election Form
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Health Benefits Election Form Form Approved: OMB No. 3206-0160 Standard Form 2809 ... If you are covered by other health insurance, either in your name or under a family member’s policy, check yes and ... You are an employee under age 26 and have no eligible
[PDF File]2018 Form 1040
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Home address (number and street). If you have a P.O. box, see instructions. Apt. no. City, town or post office, state, and ZIP code. If you have a foreign address, attach Schedule 6. Full-year health care coverage or exempt (see inst.) Presidential Election Campaign (see inst.) You . Spouse. If more than four dependents, see inst. and here
[PDF File]Application for Social Security Card
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health insurance card, Medicaid card, or school identity card/record. For young children, we may accept medical records (clinic, doctor, or hospital) maintained by the medical provider. We may also accept a final adoption ... that you have a Social Security number. Contact us to see if your reason qualifies for a Social Security number.
[PDF File]The Mood Disorder Questionnaire (MDQ) - Overview
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The Mood Disorder Questionnaire (MDQ) - Overview The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists, researchers and consumer advocates to address the need for timely and accurate evaluation of bipolar disorder. Clinical Utility n The MDQ is a brief self-report instrument that takes about 5 minutes to complete.
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