Baltimore county employee portal

• [PDF File]Form SSA-89 (02-2018) Discontinue Previous Editions Page 1 of ...

  https://info.5y1.org/baltimore-county-employee-portal_1_ef6bef.html

  I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent, if applicable, for the purpose I identified. The name and address of the Company's Agent is: I am the individual to whom the Social Security number was issued or the parent or legal guardian of a

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• [PDF File]Statement of Claimant or Other Person - The United States ...

  https://info.5y1.org/baltimore-county-employee-portal_1_aa5fe8.html

  Form SSA-795 (09-2015) ef (09-2015) Destroy Prior Editions. Social Security Administration. STATEMENT OF CLAIMANT OR OTHER PERSON. Form Approved OMB No. 0960-0045 Name of Wage Earner, Self-employed Person, or SSI Claimant

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• [PDF File]Form W-9 (Rev. October 2018)

  https://info.5y1.org/baltimore-county-employee-portal_1_7ff93a.html

  Form W-9 (Rev. 10-2018) Page . 2 By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a

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• [PDF File]Designation of Beneficiary

  https://info.5y1.org/baltimore-county-employee-portal_1_869a27.html

  an employee a retiree a compensationer If the Insured is retired or receiving Federal Employees' Compensation, give CSA, CSI, or OWCP claim number: Department or agency where the Insured works (If retired, last department or agency where the Insured worked): Department or agency Bureau or division Location (city, state, and ZIP code)

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• [PDF File]Certification of Health Care Provider for Employee’s Serious ...

  https://info.5y1.org/baltimore-county-employee-portal_1_9679a0.html

  require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Please complete Section I before giving this form to your employee. Your response is voluntary.

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• [PDF File]Declaration for Federal Employment* OMB No. 3206-0182

  https://info.5y1.org/baltimore-county-employee-portal_1_34736d.html

  Declaration for Federal Employment* (*This form may also be used to assess fitness for federal contract employment) Form Approved: OMB No. 3206-0182 U.S. Office of Personnel Management

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• [PDF File]Supplemental and Optional Contact Information for HUD ...

  https://info.5y1.org/baltimore-county-employee-portal_1_f96e7c.html

  OMB Control # 2502-0581 Exp. (02/28/2019) Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING

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• [DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal

  https://info.5y1.org/baltimore-county-employee-portal_1_8f9cb8.html

  The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit an inquiry to AEVS to verify a recipient’s eligibility for

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• [DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy

  https://info.5y1.org/baltimore-county-employee-portal_1_6955d1.html

  navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,

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• [PDF File]INSTITUTIONAL PROVIDERS CMS-855A

  https://info.5y1.org/baltimore-county-employee-portal_1_4fefb9.html

  medicare enrollment application . institutional providers cms-855a . see page 1 to determine if you are completing the correct application see page 3 for information on where to mail this application. see page 52 to find a list of the supporting documentation that must be submitted with this application.

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