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PREMIUM ASSISTANCE PROGRAM Employer Application & Certification Form 1. Answer each question or enter “N/A “2. Please ELECTRONICALLY fill and resurrection I: EMPLOYER INFORMATION Employer/Business
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Who needs premium assistance program employer?

01
The premium assistance program employer is needed by individuals or organizations who want to provide their employees with additional financial support for insurance premiums.
02
Employers who want to offer premium assistance to their employees but require assistance from a government program may also need to participate in the premium assistance program employer.
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The premium assistance program employer is an employer who provides or contributes to a premium assistance program for their employees.
Employers who offer a premium assistance program to their employees are required to file the premium assistance program employer.
To fill out the premium assistance program employer, employers must provide information about the program they offer, the benefits provided, and the contributions made.
The purpose of the premium assistance program employer is to report the details of the premium assistance program provided to employees for tax and regulatory compliance purposes.
Employers must report details such as the name of the program, benefits provided, contributions made, and any other relevant information on the premium assistance program employer.
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