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This form may be completed online, printed and mailed to the address listed below. Check one: Fees: 1-10 beds $950 11-20 beds $1,450 21-50 beds $1,650 51 or more $1,950 Make fee payable to HHS STATE
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Applicable - Nebraska Health refers to the health coverage information that must be reported to the state of Nebraska.
Employers or insurers who provide health coverage in Nebraska are required to file Applicable - Nebraska Health forms.
Applicable - Nebraska Health forms can be filled out electronically through the Nebraska Department of Revenue website or through approved software providers.
The purpose of Applicable - Nebraska Health is to provide the state with information on health coverage provided to residents for tax and regulatory purposes.
Information such as the name and social security number of covered individuals, the months of coverage, and the type of coverage must be reported on Applicable - Nebraska Health forms.
The deadline to file Applicable - Nebraska Health forms in 2023 is typically January 31st.
The penalty for late filing of Applicable - Nebraska Health forms can vary, but can be up to $280 per form if not filed by the deadline.
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