EBSA FORM CERTIFICATION revised August This form may be used to certify that the health coverage established or maintained or arranged by the organization listed below qualifies for an accommodati
9815 2713A 29 CFR 2590715 2713A and 45 CFR 147131 Alternatively an eligible organization may also provide notice to the Secretary of Health and Human Services Plea se fill out this form completely This form should be made available for examination up
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