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Anaheim California online Form 5500 - Schedule I: What You Should Know

A copy of the death certificate, if applicable, and a list of medical records that support or support the certification must accompany the notice. Also, as necessary, the notice must include: (i) a statement of the individual's relationship to the individual's spouse, such as a spouse's name, birthdate, and Social Security Number; and (ii) the names and Social Security Numbers of the individual's dependent parents and their spouses; and (iii) information on any health insurance in the individual's name (i) that is not current, (ii) that is available but no longer applies to health insurance coverage for the individual, (iii) that has expired and has not been renewed, or (iv) that is obtained or has been obtained but not yet paid. (1) For each individual's family members, the notice must contain the following: 1. A statement that: (A) The individual's family member(s) must apply for an original or replacement copy of the notice through the address listed on the form. (B) If your name is included in a Notice of Intent to File a Report, the individual's family member(s) will not have to apply for an original or replacement copy through the address listed on Form 8959. The individual's family member must apply for an original or replacement copy of this notice. If you are using Form 8959 or a Form 3903(R) to file an original or replacement copy of the notice, then all of your family member(s) whose name is listed in the Notice of Intent to File will be required to apply for an original or replacement copy of the notice through the address listed on that form. (D) The individual's family member shall be notified in writing of the date and time when the individual's death was certified as a result of a terminal illness or condition. The notice must be sent via U.S. mail, certified mail, return receipt requested to each of the appropriate address provided on the form.

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