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Request to Inspect or Receive a Copy of Protected Health Information Complete and mail this form to: Privacy Officer UNITE HERE HEALTH P.O. Box 6020 Aurora, Illinois 605980020Participant Name Participant

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What is this page has been?

This page has been a form used for reporting specific financial or tax information to the relevant authorities.

Who is required to file this page has been?

All individuals or entities who meet certain criteria specified by the tax authorities are required to file this page.

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The purpose of this page is to collect relevant financial data for assessment, compliance, and record-keeping by the tax authorities.

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