Employee Health Insurance Responsibility Disclosure Form
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Key components of the responsibility disclosure form purpose of the form right at the top of the document, you should include a paragraph explaining why the employee is required to fill the form. This reporting is administered by masshealth and the department of revenue (dor) through the masstaxconnect (mtc) web portal. Sign online button or tick the preview image of the form. Note to employer regarding employee signature if the employee refuses to sign and date the form, the refusal should be noted in writing and signed by the
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Web The Employee Must Sign And Date The Employee Health Insurance Responsibility Disclosure (Hird) Form.
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