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Exhibit 1 Model Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (Part C)
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
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United States Federal Legal Forms
Health Coverage
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Form CMS-18-F-5 Application for Part a (Hospital Insurance)
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
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Form CMS L564/R297 Request for Employment Information
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Social Security Forms
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
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Form DOH-5794 Manufacturers and Distributors Supervisor Attestation - New York
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New York State Department of Health
New York Legal Forms
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Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York (Haitian Creole)
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New York State Department of Health
New York Legal Forms
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Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York (Italian)
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New York State Department of Health
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Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York
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New York State Department of Health
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Formulario DOH-4220 Solicitud De Seguro Medico Para Adultos Mayores, Personas Con Discapacidades Y Otros Grupos Determinados - New York (Spanish)
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New York State Department of Health
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Formulario De Solicitud
Seguro Medico
Adulto Mayor
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Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York (Polish)
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New York State Department of Health
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Resumen De Beneficios Y Cobertura (Spanish)
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
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Summary of Benefits and Coverage (Chinese)
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Health Insurance Form
U.S. Department of Health and Human Services
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U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
Insurance Benefits
Health Plan
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Healthcare Services
Coverage Details
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Application for Health Coverage & Help Paying Costs (Short Form)
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
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Application for Health Coverage - Individual Without Financial Assistance
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Affordable Care Act Form
U.S. Department of Health and Human Services
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U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
Health Coverage
Coverage Options
Eligibility Requirements
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Instructions for Application for Health Coverage & Help Paying Costs (Short Form)
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Health Insurance Form
Affordable Care Act Form
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Insurance Enrollment Form
Health Care Form
U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
United States Federal Legal Forms
Health Benefits
Health Coverage
Health Savings Account
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Form CMS-43 Application for Hospital Insurance Benefits for Individuals With End Stage Renal Disease
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U.S. Department of Health and Human Services
U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
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End Stage Renal Disease
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Form CMS-4040 Request for Enrollment in Supplementary Medical Insurance
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Health Insurance Form
U.S. Department of Health and Human Services
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Hvrp Application - Washington, 2024
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Washington State Department of Veterans Affairs
Washington Legal Forms
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Veterans Benefits
Supported Employment
Education Benefits
Veteran Services
Government Assistance
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Instructions for Request for Authorization to Travel - Louisiana
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Travel Expense Form
Louisiana Legal Forms
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Louisiana Department of Health
Request for Authorization
Travel Policy
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Form DEP4057 Application for Variance From Chapter 62-6, Fac - Florida
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Florida Legal Forms
Florida Department of Environmental Protection
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Form TC-829 Application to Rescind Dismantling Permit - Utah
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Utah State Tax Commission
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Form TC-895 Application to Request a Motor Vehicle Account - Utah
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Utah State Tax Commission
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Ohio Feed Registration Application - Ohio
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Ohio Legal Forms
Ohio Department of Agriculture
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Primer Reporte - Montana (Spanish)
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Montana Department of Labor and Industry
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Form MH281 Payer Financial Information - County of Los Angeles, California
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California Legal Forms
Department of Mental Health - County of Los Angeles, California
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Declaration of Candidacy - New Hampshire
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New Hampshire Legal Forms
New Hampshire Secretary of State
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Standard Telework Agreement - Virginia
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Virginia Legal Forms
Virginia Department of Human Resource Management
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Telework Policy
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Application for Registration for Srm Diagnostic X-Ray Equipment Facility - Rhode Island
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Rhode Island Legal Forms
Rhode Island Department of Health
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Application for Registration for Dental Diagnostic X-Ray Equipment Facility - Rhode Island
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Rhode Island Legal Forms
Rhode Island Department of Health
Equipment Facility
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Application for Registration for Facilities Utilizing X-Rays for Non-healing Arts - Oth - Rhode Island
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Request for National Criminal Information Center (Ncic) Background Check - Rhode Island
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Background Check Form
Criminal Background Check Form
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Rhode Island Department of Health
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Application for License as a Marriage & Family Therapist Associate - Rhode Island
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Rhode Island Department of Health
Family Therapist
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Application for License as a Barber Instructor/Hairdresser Instructor/Manicurist Instructor/Esthetician Instructor - Rhode Island
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Application for Shop License - Rhode Island
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Application for License as a Hairdresser/Barber/Manicurist/Esthetician - Rhode Island
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Hospital Conversion or Merger Initial Application - Rhode Island
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Rhode Island Department of Health
Regulatory Approval
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Form F252-022-000 Firm Vocational Provider Change Form - Washington
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Washington State Department of Labor and Industries
Washington Legal Forms
Provider Change
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Apprenticeship State Grant Application - Washington, 2024
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Washington State Department of Labor and Industries
Washington Legal Forms
State Grant
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Instructions for Arizona Form 325, ADOR10945, Arizona Form 325-P, ADOR11280 - Arizona, 2022
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Tax Instructions
Arizona Department of Revenue
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Arizona Form 821 (ADOR10172) Withholding Tax Information Authorization - Arizona
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Arizona Department of Revenue
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Individual CPA Certificate Renewal - Minnesota, 2024
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Minnesota Legal Forms
Minnesota Board of Accountancy
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