Form E5215 Health Insurance Affidavit - Franklin County, Ohio

Form E5215 Health Insurance Affidavit - Franklin County, Ohio

What Is Form E5215?

This is a legal form that was released by the Court of Common Pleas - Franklin County, Ohio - a government authority operating within Ohio. The form may be used strictly within Franklin County. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form E5215?
A: Form E5215 is a Health Insurance Affidavit used in Franklin County, Ohio.

Q: What is the purpose of Form E5215?
A: The purpose of Form E5215 is to verify an individual's health insurance coverage.

Q: Who needs to fill out Form E5215?
A: Any individual who is a resident of Franklin County, Ohio and is required to provide proof of health insurance coverage.

Q: Is Form E5215 mandatory?
A: Yes, if you are a resident of Franklin County, Ohio and are required to provide proof of health insurance coverage, you must fill out and submit Form E5215.

Q: What information do I need to provide on Form E5215?
A: You will need to provide your personal information, including your name, address, social security number, and information about your health insurance coverage.

Q: Are there any penalties for not filling out Form E5215?
A: Failure to submit Form E5215 or providing false information may result in penalties, including loss of eligibility for certain benefits.

Q: When do I need to submit Form E5215?
A: You should submit Form E5215 as soon as possible if you are required to provide proof of health insurance coverage.

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Form Details:

  • Released on November 1, 2020;
  • The latest edition provided by the Court of Common Pleas - Franklin County, Ohio;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form E5215 by clicking the link below or browse more documents and templates provided by the Court of Common Pleas - Franklin County, Ohio.

Download Form E5215 Health Insurance Affidavit - Franklin County, Ohio

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