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Get Box 989725
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How to fill out the Box 989725 online
Filling out the Box 989725 is an essential step in obtaining financial assistance for your health plan. This guide will provide you with detailed instructions on completing the form accurately and effectively.
Follow the steps to complete the Box 989725 online.
- Press the ‘Get Form’ button to access the Box 989725 document and open it for online editing.
- In the first section, enter your full printed name in the space provided for the person's name who is attesting their income.
- Next, indicate your household’s projected annual income by filling in the appropriate amount in the designated field.
- Review the acknowledgement section. Ensure you understand that the information you provide will be kept private and will solely be used for determining eligibility for financial assistance.
- Read the sections about reporting income changes and potential consequences of receiving excess premium assistance. It is crucial to understand your responsibilities regarding income reporting.
- Sign the document in the space provided for your signature, confirming that the statements you have made are true and correct.
- Enter the current date in the MM/DD/YYYY format in the space designated for the date.
- After completing the form, you can save your changes, download it, print a copy for your records, or share it as needed.
Complete your Box 989725 online today to access the health insurance financial assistance you need.
The limits are based on both household income and household size. In 2022, an individual in a one-person household is eligible for some degree of Covered California subsidies if they earn up to $51,520. Meanwhile, that limit rises to $106,000 for a household size of 4.
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