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H ice
1111Disclosure and Release Authorization
First Name:Middle Name:Last Name:
Date Last Used:Maiden Name/Other Names Used:
Date of Birth:Social Security Number:[ ] Femaleness: From:Address:
City:sex:[
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What is h ice?
H ICE stands for Health Insurance Coverage Exemption.
Who is required to file h ice?
Individuals who are seeking an exemption from the requirement to have health insurance coverage.
How to fill out h ice?
To fill out H ICE, individuals need to provide information about their exemption type and supporting documentation.
What is the purpose of h ice?
The purpose of H ICE is to apply for an exemption from the health insurance coverage requirement.
What information must be reported on h ice?
Information such as exemption type, supporting documentation, and personal information may be required to be reported on H ICE.
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