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HA01090920State Health Benefits Program (SHIP) School Employees Health Benefits Program (SE HBP)ACTIVE LOCAL GOVERNMENT AND LOCAL EDUCATION EMPLOYEE GROUPEMPLOYEE COVERAGE WAIVER/REINSTATEMENT FOREPART
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1. Obtain the form from the designated authority or website.
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Read the instructions carefully to understand the requirements.
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Fill in your personal information such as name, address, and contact details in the given fields.
04
Provide information about your local government, including its name, jurisdiction, and type.
05
Mention the duration for which you have been an active member of the local government.
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Include details of any specific roles or responsibilities you have undertaken.
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Attach supporting documents if required, such as proof of membership or contributions to the local government.
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What is ha0109 active local government?
HA0109 Active Local Government is a form or document used by local governments to report and maintain active status regarding their operations and governance.
Who is required to file ha0109 active local government?
Local government entities such as cities, counties, and municipalities are required to file the HA0109 form.
How to fill out ha0109 active local government?
To fill out HA0109, local governments need to provide necessary details including government services, financial reports, and organizational structure, following the guidelines provided in the filing instructions.
What is the purpose of ha0109 active local government?
The purpose of HA0109 Active Local Government is to ensure transparency and accountability in local government operations and provide updated information to state officials.
What information must be reported on ha0109 active local government?
Information that must be reported includes the name of the local government, services provided, financial data, governing officials, and contact information.
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