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Adams® Employee Certification of Cancellation of Dependent Health Coverage, 1-Use Interactive Digital Legal Form CANCELLED

Item: 1679703   Model: DLF513-SL
$6.99 Each

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  • Easy-to-follow questionnaire
  • After completing your online questionnaire, document is instantly available
  • Download completed forms after online assembly

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).

  • Easy-to-follow questionnaire
  • After completing your online questionnaire, document is instantly available
  • Download completed forms after online assembly
  • Web browser: Microsoft Internet Explorer 7.0 or higher , Mozilla Firefox , Google Chrome , Safari 6.0 and earlier , Android standard browser
  • Print as many copies as you need
  • Step-by-step instructions included with your assembled form help you to file or execute your documents correctly
  • Legal forms created by attorneys
  • Valid for every state

Legal Form ClassSmall Business

Legal Form TypeHR/Personnel

Digital or Preprinted FormDigital Form

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