Get the free www.vba.va.govpubsforms(DO NOT WRITE IN THIS SPACE) APPOINTMENT OF VETERANS SERVICE ...
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PLEASE READ THE ENTIRE CONTRACT BEFORE SIGNING Lessee Contact Name: Organization/Event: Mailing Address: Postal Code Telephone (Hm): (Wk): (Cell): Alternate Contact: Telephone: Agreement: I (we) (hereafter
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It is a form used for reporting certain information to the VA.
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Employers who have employees that are covered by the VA.
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The form must be filled out with accurate information about the covered employees.
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The purpose is to provide the VA with information about the health coverage offered to employees.
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Information such as the number of covered employees, the type of coverage offered, and the cost of the coverage.
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