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Brief Intake Assessment Sample Cobra Version 6-06 CLIENT ID # Referral Date (Referred to Case Management Program) INTAKE DATE Referred by: Last Name First Name M.I. Does client prefer to be referred
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What is brief intake assessment cobra?
Brief intake assessment cobra is a form that collects information about an individual's Cobra coverage eligibility.
Who is required to file brief intake assessment cobra?
Employers or plan administrators who offer Cobra coverage are required to file brief intake assessment cobra.
How to fill out brief intake assessment cobra?
Brief intake assessment cobra can be filled out by providing the necessary information about an individual's Cobra coverage eligibility as requested on the form.
What is the purpose of brief intake assessment cobra?
The purpose of brief intake assessment cobra is to gather information about an individual's Cobra coverage eligibility for administrative and tracking purposes.
What information must be reported on brief intake assessment cobra?
Brief intake assessment cobra typically requires information such as the individual's name, contact details, Social Security number, employment status, qualifying event, and related details.
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