Employee Health Insurance Responsibility Disclosure Form
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Last Updated October 28, 2022.
Sign online button or tick the preview image of the form. Web the employee must sign and date the employee health insurance responsibility disclosure (hird) form. Note to employer regarding employee signature if the employee refuses to sign and date the form, the refusal should be noted in writing and signed by the This reporting is administered by masshealth and the department of revenue (dor) through the masstaxconnect (mtc) web portal.
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Web Employee Health Insurance Responsibility Disclosure (Hird) Form Contains Information That Must Be Reported In My Massachusetts Tax Return, And That I Am Required To Maintain A Copy Of The Signed Hird Form.
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