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BRA/PST Acknowledgement Card(Please complete and submit to your Payroll Center)Beneficiary Informational Information×If there are additional beneficiaries, please attach a separate sheet. Employer

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How to fill out obra acknowledgement card

01

To fill out the OBRA acknowledgement card, follow these steps:

02

Start by writing your full name in the designated space on the card.

03

Next, provide your contact information, including your address, phone number, and email address.

04

Indicate your date of birth on the card.

05

Specify your gender (male, female, or other).

06

Include your Social Security number.

07

If applicable, provide your Medicaid number.

08

Sign and date the acknowledgement card.

09

Make sure to review the information you have provided for accuracy and completeness before submitting the card.

Who needs obra acknowledgement card?

01

The OBRA acknowledgement card is required for individuals who are beneficiaries under the Omnibus Budget Reconciliation Act of 1990 (OBRA). This card is typically needed by individuals who receive Medicaid benefits or are enrolled in certain healthcare programs that fall under OBRA regulations.

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What is obra acknowledgement card?

The obra acknowledgement card is a form used to report earnings and other information for individuals who have received payments from an employer.

Who is required to file obra acknowledgement card?

Employers are required to file obra acknowledgement cards for any individual who has received payments from the employer.

How to fill out obra acknowledgement card?

The obra acknowledgement card can be filled out manually or electronically, and must include information such as the individual's name, social security number, and total earnings.

What is the purpose of obra acknowledgement card?

The purpose of the obra acknowledgement card is to report earnings for individuals who have received payments from an employer, and to ensure compliance with tax laws.

What information must be reported on obra acknowledgement card?

Information such as the individual's name, social security number, and total earnings must be reported on the obra acknowledgement card.

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