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20212022 Low/No Income Verification Dependent (DLI) STUDENT NAME: ___STUDENT ID #: ___ADDRESS: ___ ___ ___ ___ STREET OR PO BOXCITYSTATEZIPThe income reported on your 20212022 FAFSA seems too low
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Gather all necessary personal information such as name, address, date of birth, and social security number.
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Include any additional documentation required, such as proof of income or residency.
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Review the completed form for any errors or missing information before submitting it to United Healthcare.

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Individuals living in Atlanta, Georgia who are seeking health insurance coverage.
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United Healthcare Atlanta GA is a health insurance company operating in Atlanta, Georgia.
Employers offering healthcare benefits through United Healthcare in Atlanta, Georgia are required to file.
United Healthcare Atlanta GA forms can be filled out online or submitted through the mail.
The purpose of United Healthcare Atlanta GA is to provide health insurance coverage to individuals and employees in Atlanta, Georgia.
Information such as employee enrollment numbers, plan details, and premium amounts must be reported on United Healthcare Atlanta GA forms.
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