NY Form 80 2021-2024

NY Form 80: What You Should Know

If you do not provide two different types of evidence of proof of employment, your application may be disqualified. Please  check application page for further instructions. Application for Health Benefit/Medical Payment Card — Application must be  notarized. F-80H-application — New York State Department of Health (May require signature) Feb 30, 2024 — The application must be filled out on paper and signed by a physician certified or licensed not to offer medical services while operating a commercial motor vehicle.  Only one health benefit/medical payment card will be issued. Please  check the application page for further instructions. F80-application-form.pdf — NYC.gov Feb 6, 2024 — Applicants must provide two forms of identifications; at least one form of identification must be government issued photo identification, such  as a driver license, state issued non-driver ID card, or NY state issued passport  and another form of government issued photo identification OR NOTE: No one will be issued a medical payment/health benefit card until they provide two different types of proof of an  existing employer (if applicable) and, if applicable, proof of employment(s) for the applicant who is an existing applicant for a health benefit/ medical payment card.  If you do not provide two different types of proof of employment, your application may be disqualified.  Please  check application page for further instructions. Application for Health Benefit/Medical Payment Card — Application must be  notarized. F-80-application-form.pdf — NYC.

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