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HAP HMO Enrollment Application be filled out by employer: Group ID:Subgroup ID:Class ID:Effective Date of Coverage:Important: List family members you are covering. Legal first name and middle initial

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The form needs to be filled out by individuals or entities who are required to provide the requested information. This can vary depending on the specific form and its purpose. Examples of individuals or entities who may need to fill out a form include job applicants, taxpayers, students applying for financial aid, insurance policyholders, etc.

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