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) Lag Date EMPLOYER STATUS REPORT For UNEMPLOYMENT COMPENSATION 713 Other Rate(s) Quarter(s) Predecessor Reg. No.: Date Rec d RETURN COMPLETED FORM TO: FORM IS TO BE TYPED OR PRINTED IN INK PLEASE COMPLETE AND RETURN THIS FORM EVEN THOUGH YOU MAY NOT BE SUBJECT TO THE CONNECTICUT UNEMPLOYMENT COMPENSATION LAW. *501(C)(3) NON-PROFIT ORGANIZATIONS SHOULD REQUEST FORM UC.

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To COBRA: Click on the “COBRA Installer” link above to download the installer. ... Locate the file “cobradotnetv4dot1.exe” on your computer and double-click to run the installer. Follow all on-screen instructions to complete the installation. To run COBRA, look for the “COBRA” entry in your “Start” menu.

If you had job-based health coverage. Depending on the kind of job-based coverage you had (including COBRA or retiree coverage), you may get one of these from your employer or insurance company: Form 1095-B, Health Coverage. Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.

The insurance carrier is responsible for reporting the COBRA qualified beneficiaries' coverage information on the separate Form 1095-B prepared, furnished (subject to the 2020 section 6055 furnishing relief), and filed by the carrier.

Form 1095-C, Part II, line 15 enter COBRA premium for the lowest-cost self-only coverage providing minimum value offered. Form 1095-C, Part II, line 16 enter Code 2C. If self-insured, complete Form 1095-C, Part III for all enrolled individuals and in column (e) check applicable months that COBRA coverage was elected.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, ...

If you were enrolled in health coverage during the year, you should receive a Form 1095-A, 1095-B, or 1095-C. In addition, if you were an employee of an employer that was an applicable large employer during the year, you may receive a Form 1095-C. If you don't fall in either of these categories, you won't receive a ...

Meet the Deadlines You should get a notice in the mail about your COBRA and Cal-COBRA rights. You have 60 days after being notified to sign up.

If you had health insurance through your employer or independently during any part of 2022, you should receive Form 1095-B from the insurance carrier. Only you, as the subscriber, will receive Forms 1095-B for your coverage.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232