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[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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Provides eligible pregnant women of any age with family planning, pregnancy-related services, including services for conditions that may complicate the pregnancy, and postpartum services if family income is at or below 213 percent of the FPL. 45 Full No FC. Covers children supported by public funds other than AFDC-FC.
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[PDF File]www.irs.gov/form8822. Part I Complete This Part To Change ...
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Treasury Internal Revenue Service Fresno, CA 93888-0023 : A foreign country, American Samoa, or Puerto Rico (or are excluding income under Internal Revenue Code section 933), or use an APO or FPO address, or file Form 2555, 2555-EZ, or 4563, or are a dual-status alien or non bona fide resident of Guam or ...
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[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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periods of leave i certify that i have sufficient funds to cover the cost of round trip travel. i understand that should any portion of this leave, if approved, result in my taking more leave than i can earn on my current un-extended enlistment or current active duty obligation, my pay will be checked for such excess leave. 22.
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[PDF File]Health Plans Tax-Favored and Other Page 1 of 22 15:37 - 4 ...
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Department of the Treasury Internal Revenue Service Publication 969 Cat. No. 24216S Health Savings Accounts and Other Tax-Favored Health Plans For use in preparing ... ministered by the Secretary of Veterans Affairs for a serv-ice-connected disability. If another taxpayer is entitled to claim an exemp-tion for you, you can’t claim a deduction ...
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[PDF File]Form Refund Due a Deceased Taxpayer
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Form 1310 (Rev. August 2014) Department of the Treasury Internal Revenue Service . Statement of Person Claiming Refund Due a Deceased Taxpayer
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[PDF File]Form W-9 (Rev. October 2018)
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Department of the Treasury Internal Revenue Service . ... funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions)
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[PDF File]Designation of Beneficiary
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1. The examples on the back of the first page of this form may be helpful to you in filling out this form. 2. Except for signatures, you should type or print all entries in ink (typing is preferred).
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[PDF File]Specific Instructions for Form 1099-R
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unclaimed property funds under escheat laws must be reported on Form 1099-R. See IRA escheatment, later. Reminders In addition, see the 2019 General Instructions for Certain Information Returns for information on the following topics. •Who must file (certain Foreign Financial Institutions (FFIs) and U.S. payers that report on Form(s) 1099 to
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[PDF File]Application for Lump-Sum Death Payment
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Social Security Administration. APPLICATION FOR LUMP-SUM DEATH PAYMENT* Form Approved OMB No. 0960-0013. Page 1. TOE 120/145/155 I apply for all insurance benefits for which I am eligible under Title II (Federal Old-Age, Survivors, and Disability Insurance) of the Social Security Act, as presently amended, on the named deceased's Social ...
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[PDF File]Designation of Beneficiary
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Designation of Beneficiary Form Approved OMB No. 3206-0173 Federal Employees Retirement System Important: Federal Employees Read all instructions before Retirement System filling in this form A. Identification Name (Last, first, middle) Date of birth (mm/dd/yyyy) Social Security Number Place an "X" in the
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Va dept of treasury unclaimed funds