
Get Dol Sf 1199a 2012-2025
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All data elements on the 1199A must be completed unless a blank is indicated. This form cannot be faxed. Send to: Division of Payment Management Regular Mail Only - PO Box 6021, Rockville, MD 20852. Express Mail Only - 11400 Rockville Pike, Suite 700, Rockville, MD 20852.
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