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COBRA NOTICE OF ELECTION (NOE) ELIGIBILITY You must also complete a Tobacco Certification form whenever the status of tobacco use changes for you or a dependent covered under your health insurance.

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What is you must also complete?

You must complete the additional section on the form related to your income.

Who is required to file you must also complete?

Any individual receiving income from multiple sources.

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You must provide information about each source of income and calculate the total amount.

What is the purpose of you must also complete?

The purpose is to ensure accurate reporting of income and prevent tax evasion.

What information must be reported on you must also complete?

You must report the amount of income, source of income, and any applicable deductions.

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