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DocuSign Envelope ID: 73F5A007BC464FE7A6AA0048C1F3907ESanFranciscoEthicsCommissionReceivedon:25VanNessAvenue,Suite220,San Francisco,CA94102 Phone:415.252.3100. Fax:415.252.3112 ethics.commission@sfgov.org.www.sfethics.org02112023

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What is fax415?

Fax415 refers to a specific form used for reporting information regarding health care coverage and employer health benefits as required by certain regulations.

Who is required to file fax415?

Employers with a certain number of employees who offer health coverage are required to file fax415.

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To fill out fax415, collect all necessary employee and health coverage information, complete each section of the form accurately, and ensure that all required fields are filled before submission.

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The purpose of fax415 is to ensure compliance with health care regulations and to report health coverage information to regulatory bodies.

What information must be reported on fax415?

Fax415 typically requires information such as employee details, health coverage details, and any relevant employer contributions to health plans.

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