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SUBMIT TO: HIPAA Unit; Suite 900 PO Box 1151 Little Rock, AR 72203-1151 FAX 501-378-2926 State of Arkansas Continuation of Coverage Election Form Employee s Name: ID #: Dependent Name(s): Group Name:
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How to fill out State of Arkansas Continuation:

01
Obtain the State of Arkansas Continuation form from the appropriate government agency or website.
02
Fill out the top section of the form by providing your name, address, and contact information.
03
Enter the name of the original state form or document that requires continuation.
04
Provide any relevant identification or account numbers in the designated fields.
05
Indicate the date of the original form or document that requires continuation.
06
Describe the information that needs to be continued on the State of Arkansas Continuation form.
07
Attach any supporting documents or additional pages, if necessary.
08
Sign and date the form to certify the accuracy of the information provided.
09
Submit the completed State of Arkansas Continuation form to the appropriate department or agency.

Who needs State of Arkansas Continuation:

01
Individuals who have filled out a state form or document that requires continuation.
02
Businesses or organizations that have submitted a state document that needs additional information.
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Anyone who has been instructed by a government agency or official to complete a State of Arkansas Continuation form for specific purposes.
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The state of Arkansas continuation is a form that must be filed by certain businesses in Arkansas to maintain their legal status.
Business entities such as corporations, LLCs, and partnerships are required to file the state of Arkansas continuation.
The state of Arkansas continuation can be filled out online on the Arkansas Secretary of State website, or it can be filed by mail.
The purpose of the state of Arkansas continuation is to ensure that businesses in Arkansas are in compliance with state regulations and maintain their legal status.
The state of Arkansas continuation typically requires information such as the business name, address, registered agent, and any changes to the business structure.
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