Adams "Employee Certification of Cancellation of Dependent Health Coverage" 1 User Web Downloaded (DLF513-SL)

Adams "Employee Certification of Cancellation of Dependent Health Coverage" 1 User Web Downloaded (DLF513-SL)

Item #: 1679703 | Model #: DLF513-SL
Adams "Employee Certification of Cancellation of Dependent Health Coverage" 1 User Web Downloaded (DLF513-SL)
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Product ID: 1679703
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The Adams online interactive forms let you instantly create high-quality legal documents tailored to your needs. These forms are powered by DirectLaw smart forms technology.

Employers or plan administrators may use this letter as a notice of late payment to an employee or beneficiary receiving group health plan coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

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