New york life financial professional
[PDF File]FL-150 INCOME AND EXPENSE DECLARATION
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Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) FL-150 [Rev. January 1, 2019]
[PDF File]Patient Health Questionnaire (PHQ-9)
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PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive
[PDF File]Consent for Release of Information
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Social Security Administration . Consent for Release of Information. Form Approved OMB No. 0960-0566. Instructions for Using this Form. Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an individual or group (for example, a doctor or an insurance company).
[PDF File]Request for Social Security Earnings Information
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financial) who is an heir at law, next of kin, beneficiary under the will or donee of property of the decedent. You must include proof of death and proof of your relationship to the deceased with your request. Is There A Fee For Earnings Information? ... Request for Social Security Earnings Information
[PDF File]U.S. Department of Labor PAYROLL Wage and Hour Division ...
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Rev. Dec. 2008 While completion of Form WH-347 is optional, it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the information collection contained in 29 C.F.R. §§ 3.3, 5.5(a).
[PDF File]Designation of Beneficiary
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Form Approved Designation of Beneficiary OMB No. 3206-0136 Federal Employees Federal Employees' Group Life Insurance (FEGLI) Program Important: Group Life Insurance (DO NOT erase or cross-out. Use a new form.) Read instructions on the Back of Part 2 before completing this form.
[PDF File]CMS-460 Medicare Participating Physician or supplier …
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MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT. Name(s) and Address of Participant* National Provider Identifer (NPI)* *List all names and the NPI under which the participant fles claims with the Medicare Administrative Contractor (MAC)/carrier with whom this agreement is being fled.
[PDF File]Form W-9 (Rev. October 2018)
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than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien; • A partnership, corporation, company, or association created or
[PDF File]Health Care Proxy - New York State Department of Health
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in New York State The New York Health Care Proxy Law allows you to appoint someone you trust — for example, a family ... including the decision to remove or provide life-sustaining treatment, unless ... such as financial decisions.
[PDF File]Form 2848 Power of Attorney For IRS Use Only Received by ...
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Check if new: Address . Telephone No. Fax No. to represent the taxpayer before the Internal Revenue Service and perform the following acts: 3. Acts authorized (you are required to complete this line 3). With the exception of the acts described in line 5b, I authorize my representative(s) to receive and
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