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King Washington Form 966: What You Should Know

This form is helpful for changes needed before or after the provider enters the provider agreement. This form is similar to Forms 5300 and 5331. DCF #75-966 Parental Medical Information Form (Form 8827-B) Parental medical information will be provided by your health care provider in the form of an electronic report. This form is used to gather and share information to assist in determining whether health insurance should be included in the child's individual or family Health Insurance Coverage Statement. DCF #82-966 State Farm Financial Form 8827A State Farm Financial is the parent company of State Farm, CGL, Federated National, FM, GMAC, National General Insurance, National Indemnity, State Farm, State Farm Insurance Company, USA, and USA Financial. The form 8827A can be used to obtain information about their policies, including the provider number for the policy. Forms & Documents This form is not available online. Taxpayer Information Return Filing Schedule G Form 8827G must be filed if the provider's annual gross premiums exceed 25,000. Filing Schedule F Form 8827G must be filed if the provider's annual gross premiums exceed 25,000. Filing Schedule H Form 8827H is only used in the event that the provider is in default at a prior date. Filing Schedule K Form 8827K is only used in the event that the provider is on a default balance before the filing due date. Filing Schedule M Form 8827M is only used if a default has been paid to the Department of Insurance by State-sponsored Health Insurance. Filing Schedule N Filing Schedule N is only required if health insurance is offered as part of the provider agreement. Filing Schedule O Filing Schedule O is only required if one or more of the following apply: the provider's annual gross premiums exceeds 1,000,000; or State-sponsored Health Insurance is used. Filing Schedule P Form 8827P is only made for a non-profit provider who provides primary coverage under a qualified health plan which provides coverage for the same services as those offered in a single-payer organization or employer-sponsored plan.

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