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WORKERS COMPENSATION INSURANCE COVERAGE INFORMATION FORM (Attach to Building Permit Application All information must be completed)A. Instructions If the applicant is a contractor within the meaning

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What is coverage information form?

The coverage information form is a document used to report information about health insurance coverage.

Who is required to file coverage information form?

Employers and health insurance providers are required to file coverage information form.

How to fill out coverage information form?

Coverage information form can be filled out online or by mail using the provided forms and instructions.

What is the purpose of coverage information form?

The purpose of the coverage information form is to provide the IRS with information about the health insurance coverage offered to individuals.

What information must be reported on coverage information form?

Information such as the name, SSN, and coverage start and end dates of individuals covered under the insurance policy must be reported on the coverage information form.

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