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The document is a Wage Verification Form used by Harris Health System to verify an employee's gross income and employment status for assistance applications. It requires the employer to provide detailed information about the employee's wages, payment frequency, benefits, and health coverage, along with the employee's written consent. Accurate completion of this form is crucial as it impacts the eligibility and benefits of the employee or their family members.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (65 Votes)
2015	4.1 Satisfied (49 Votes)
2013	4.4 Satisfied (184 Votes)

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