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Return this form to: State of Hawaii Dept. of Human Services Request Division ___ ___ ___CLEAR FORM Case Number: ___ Telephone Number: ___ Fax Number: ___RE: MEDICAL ASSISTANCE ELIGIBILITY RENEWAL
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What is return this form to?
Return this form to the designated tax authority.
Who is required to file return this form to?
All individuals or entities who meet the criteria set by the tax authority.
How to fill out return this form to?
Fill out the form with accurate and complete information as required by the tax authority.
What is the purpose of return this form to?
The purpose of this form is to report income, expenses, and other relevant financial information to the tax authority.
What information must be reported on return this form to?
Income, expenses, deductions, credits, and any other relevant financial information as required by the tax authority.
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