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HA08901217School Employees Health Benefits Program (SE HBP)EDUCATION ACTIVE EMPLOYEE GROUPHEALTH BENEFITS ENROLLMENT and/or CHANGE FORM 1. EMPLOYEE INFORMATION Last NameFirstMIDIVISION USE ONLY Effective

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To fill out ha-0890-1217, follow these steps:

02

Start by entering your personal details such as your full name, address, and contact information in the designated fields.

03

Provide information about your current employment status, including your job title, employer's name, and duration of employment.

04

Indicate whether you have any other sources of income or if you receive benefits from any government programs.

05

Fill in the section related to your financial information, including details about your monthly income and expenses.

06

If you have any dependents, state their names and provide information about their relationship to you.

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Finally, review the form to ensure all the information you provided is accurate and complete. Sign and date the form before submitting it as instructed.

Who needs ha-0890-1217?

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ha-0890-1217 is needed by individuals who are applying for financial assistance or benefits from a government program. This form helps determine an individual's eligibility and assess their financial situation. It may be required for various purposes such as applying for unemployment benefits, housing assistance, or other financial aid programs.

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What is ha-0890-1217?

ha-0890-1217 is a tax form used to report income and deductions.

Who is required to file ha-0890-1217?

Individuals and businesses with taxable income must file ha-0890-1217.

How to fill out ha-0890-1217?

To fill out ha-0890-1217, you must provide information about your income, deductions, and any other relevant financial information.

What is the purpose of ha-0890-1217?

The purpose of ha-0890-1217 is to report taxable income and deductions to the tax authorities.

What information must be reported on ha-0890-1217?

Information such as income from employment, investments, deductions for expenses, and tax credits must be reported on ha-0890-1217.

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