![United States National Health Care Act / Government / Health insurance / United States / Income tax in the United States / Flexible spending account / Taxation in the United States / Social Security / Medicare United States National Health Care Act / Government / Health insurance / United States / Income tax in the United States / Flexible spending account / Taxation in the United States / Social Security / Medicare](https://www.pdfsearch.io/img/6a86d4d66f6fb11cdbe85b557b7a2a0d.jpg) Date: 2014-10-02 14:01:08United States National Health Care Act Government Health insurance United States Income tax in the United States Flexible spending account Taxation in the United States Social Security Medicare | | Declaration of Tax Status You must complete and submit this form with your enrollment form when enrolling an individual on your PEBB coverage who does not qualify as your dependent for tax purposes (for example, a state-Add to Reading ListSource URL: www.hca.wa.govDownload Document from Source Website File Size: 221,80 KBShare Document on Facebook
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