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  • Tx Form 3f012 2014

Get Tx Form 3f012 2014-2026

Office of the Attorney General MEDICAL SUPPORT UNIT P.O. BOX 1328 AUSTIN, TX 7876713285 Toll-free (800) 5222421 Fax (855) 3296676 Bar code Area (w/ FSN) F019 FS# F019 Date: F002 Custodial Parent F032.

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How to fill out the TX Form 3F012 online

Completing the TX Form 3F012 online is an essential step for employers to report changes in health insurance status or employment for employees. This guide provides clear and concise instructions tailored to help users navigate the form effectively.

Follow the steps to fill out the TX Form 3F012 online correctly.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Identify the section for the custodial parent and non-custodial parent. Enter the required names in the spaces labeled <F032> and <F024> respectively.
  3. Fill in the Attorney General Case number in the designated field <F003>.
  4. Complete the additional fields <F004> to <F010> with the relevant information as needed, including the health insurance status and any employment-related changes.
  5. In the ‘Social Security Number’ field <F022>, enter the obligor's Social Security Number as required.
  6. Provide the ‘Date of occurrence’ when the change in status took place.
  7. Indicate if the obligor is no longer employed or if health insurance coverage has lapsed by checking the appropriate box.
  8. If applicable, complete the obligor’s last known home address and new employer information in the fields provided.
  9. Fill in the telephone number and any other relevant details in the sections available.
  10. Sign the form in the Signature section and enter your position/title, along with a contact number and internet/web address if required.
  11. Once all fields are filled out, users can save changes to the document, download, print, or share the form as necessary.

Complete your documents online today and ensure your compliance with health insurance notification requirements.

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