Plumbers Local 344 - Redacted Bates HWM

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Plumbers L344:000001

file:///C|/...aivers%20FOIA%20-%20Second%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/waiver.htm[08/23/2011 3:57:07 PM]

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From:                                         Andrea Peery [[email protected]] Sent:                                           Tuesday, November 30, 2010 2:58 PM To:                                               OCIIO Oversight; HHS HealthInsurance (HHS) Subject:                                     waiver Attachments:                          App for Waiver 2010.pdf   Importance:                            High           Andrea Peery   Benefits Specialist Plumbers & Pipefitters Local 344 H&W 4337 SW 44th St OKC, OK 73119 p: 405-682-4571 ext. 23 f: 405-682-4584  

Document obtained by CompleteColorado.com

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Document obtained by CompleteColorado.com

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Plumbers L344:000002

Document obtained by CompleteColorado.com

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Plumbers L344:000003

Document obtained by CompleteColorado.com

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Plumbers L344:000004

Document obtained by CompleteColorado.com

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Plumbers L344:000005

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Document obtained by CompleteColorado.com

Pages 6 through 13 redacted for the following reasons: ---------------------------Exemption 4

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Plumbers L344:000006

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From: Moultrie, Cam (HHS/OCIIO) Sent: Tuesday, December 21, 2010 4:17 PM To: [email protected] Cc: Pereira, Alix (HHS/OCIIO); Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Pipefitters Local Union 344 Health and Welfare Plan Thank you for your information.  Your application is now complete and you will receive a determination of your application within 30 days.    Thank you.
    Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        
 

Document obtained by CompleteColorado.com

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

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Plumbers L344:000007

 

file:///C|/...20-%20Second%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Completion%2012.21.10.htm[08/23/2011 3:57:09 PM]

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    Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        
 

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

 

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From: Moultrie, Cam (HHS/OCIIO) Sent: Monday, December 13, 2010 5:00 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Plumbers and Pipefitters Local Union 344 Health and Welfare Plan Dear Applicant:   Thank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711.  In order to expedite your application, please provide the following information:   I.                    Please complete the entire annual limits spreadsheet available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html.  Please return the completed spreadsheet to this email address as an attachment.  We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested).  If a cell on the spreadsheet does not pertain to your plan, please write “None,” and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.   II.                In addition, please provide the following information:    ·          Confirm whether the plan was in existence prior to March 23, 2010.  If so, is the plan in compliance with grandfathering provisions, pursuant to 45 CFR 147.140?   ·          Confirm whether your plan provides any lifetime limits.    ·          Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective date of your collective bargaining agreement.   In order to complete your application, please provide this information by 5:00 pm, December 15, 2010.  Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS).  As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application.  You will receive an e-mail from HHS notifying you of the waiver decision.    Thank you. 

Document obtained by CompleteColorado.com

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file:///C|/...ond%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Request%20for%20info%2012.13.10.htm[08/23/2011 3:57:09 PM]

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Plumbers L344:000008

From:                                         Pereira, Alix (HHS/OCIIO) Sent:                                           Monday, December 20, 2010 4:42 PM To:                                               'Andrea Peery' Cc:                                               Sheer, Jennifer (HHS/OCIIO) Subject:                                     Plumbers and Pipefitters Local Union 344 Annual Limit Waiver Attachments:                          Waiver Application Form.xls   Importance:                            High   Dear Ms. Peery,

Document obtained by CompleteColorado.com

  Thank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711 on behalf of Plumbers and Pipefitters Local Union 344 Health and Welfare Plan.  In order to expedite your application, please provide the following information:   I.                    Please complete the entire annual limits spreadsheet, [attached to the email] [and available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html] by filing out a row for each employee tier offered (i.e. employee only, employee + 1 dependent, etc) in each plan (see column AK in the spreadsheet).  Please return the completed spreadsheet to this email address as an attachment.  We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested).  If a cell on the spreadsheet does not pertain to your plan, please write “None,” and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.    ·          Your application narrative states that 875 active and 213 retirees are currently in the fund. When filling out the spreadsheet, please note the number of dependents as well.   II.                In addition, please provide the following information:   ·          Confirm whether the plan was in existence prior to March 23, 2010.  If so, is the plan in compliance with grandfathering provisions, pursuant to 45 CFR 147.140?   ·          Your application narrative infers that your plan was created pursuant to the Taft-Hartley Act.  Please confirm if it is a Taft Hartley Plan and please provide the date for which the Collective Bargaining Agreement was enacted and the date it will expire.   ·          Please include an physical address.   ·          Your application narrative does not clearly indicate the name and contact information for the plan trustees. Only their signatures are available.     In order to complete your application, please provide this information by 5:00 pm, December 22, 2010.  Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS).  As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application.  You will receive an e-mail from HHS notifying you of the waiver decision.    Thank you. 
  _________ Alix Pereira, J.D.
Office of Consumer Support | Office of Consumer Information and Insurance Oversight (OCIIO)
Plumbers L344:000009

file:///C|/...344/Plumbers%20and%20Pipefitters%20Local%20Union%20344%20Annual%20Limit%20Waiver%20Dec%2020%202010.htm[08/23/2011 3:57:09 PM]

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Department of Health and Human Services (HHS)   (301) 492- 4156 | [email protected]  

Document obtained by CompleteColorado.com

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.   It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.

     

From: Andrea Peery [mailto:[email protected]] Sent: Tuesday, November 30, 2010 2:58 PM To: OCIIO Oversight; HHS HealthInsurance (HHS) Subject: waiver Importance: High

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Plumbers L344:000010

          Andrea Peery   Benefits Specialist Plumbers & Pipefitters Local 344 H&W 4337 SW 44th St OKC, OK 73119 p: 405-682-4571 ext. 23 f: 405-682-4584  

file:///C|/...344/Plumbers%20and%20Pipefitters%20Local%20Union%20344%20Annual%20Limit%20Waiver%20Dec%2020%202010.htm[08/23/2011 3:57:09 PM]

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From: Moultrie, Cam (HHS/OCIIO) Sent: Monday, December 20, 2010 5:45 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application for Plumbers and Pipefitters Local Union 344 Health and Welfare Plan
We have not received the requested information.  Please contact me tomorrow if you still want us to process this application.     Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

Document obtained by CompleteColorado.com

 

 

Dear Applicant:   Thank you for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711.  In order to expedite your application, please provide the following information:   I.                    Please complete the entire annual limits spreadsheet available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html.  Please return the completed spreadsheet to this email address as an attachment.  We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested).  If a cell on the spreadsheet does not pertain to your plan, please write “None,” and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.   II.                In addition, please provide the following information:    ·          Confirm whether the plan was in existence prior to March 23, 2010.  If so, is the plan in compliance with grandfathering provisions, pursuant to 45 CFR 147.140?   ·          Confirm whether your plan provides any lifetime limits.    ·          Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective date of your collective bargaining agreement.   In order to complete your application, please provide this information by 5:00 pm, December 15, 2010.  Once this information is received and the application is complete, it will be processed by the Department of Health and Human

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From: Moultrie, Cam (HHS/OCIIO) Sent: Monday, December 13, 2010 5:00 PM To: '[email protected]' Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Plumbers and Pipefitters Local Union 344 Health and Welfare Plan

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file:///C|/...ond%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Request%20for%20info%2012.20.10.htm[08/23/2011 3:57:10 PM]

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Plumbers L344:000011

Document obtained by CompleteColorado.com Services (HHS).  As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application.  You will receive an e-mail from HHS notifying you of the waiver decision.    Thank you. 

 

 

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Plumbers L344:000012

file:///C|/...ond%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Request%20for%20info%2012.20.10.htm[08/23/2011 3:57:10 PM]

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

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    Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        

From: Moultrie, Cam (HHS/OCIIO) Sent: Tuesday, December 21, 2010 1:01 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Plumbers and Pipefitters Local 344
I received your fax.   Thank you.   Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        
 

Document obtained by CompleteColorado.com

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

 

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Plumbers L344:000013

file:///C|/...%20Second%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Correspondence%2012.21.10.htm[08/23/2011 3:57:10 PM]

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.  It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information.  Unauthorized disclosure may result in prosecution to the full extent of the law.

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    Cam Lynne Moultrie Office of Consumer Information and Insurance Oversight U.S. Department of Health and Human Services (301) 492-4174 [email protected]        

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Plumbers L344:000014

file:///C|/...ond%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Request%20for%20info%2012.28.10.htm[08/23/2011 3:57:10 PM]

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From: Moultrie, Cam (HHS/OCIIO) Sent: Tuesday, December 28, 2010 1:48 PM To: [email protected] Cc: Habit, Sandra (HHS/OCIIO) Subject: Waiver Application for Plumbers and Pipefitters Local Union 344 Health and Welfare Plan I.                    In addition, please provide the following information:    ·          Confirm whether the plan was in existence prior to March 23, 2010.  If so, is the plan in compliance with grandfathering provisions, pursuant to 45 CFR 147.140?   ·          Confirm whether your plan provides any lifetime limits.    ·          Confirm whether the plan was created pursuant to the Taft-Hartley Act and, if applicable, the effective date of your collective bargaining agreement.

Document obtained by CompleteColorado.com

Document obtained by CompleteColorado.com

Annual Limit Policy Name Applicant (use a new Waiver (Plan/ Plan/ Policy row for each Applicant Request Policy Effective Date policy (Plan/ Policy Applicant ID Applicant application) Situs) City Situs) State (mm/dd/yyyy) Name Number

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Contact Name Street Address

City

State

Zip Code

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Plumbers and Pipefitters Local Union 101129-007 344

Oklahoma City

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OK 01/01/2011 Andrea Perry

4337 SW 44th Street

Oklahoma

OK

73119

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Plumbers L344:000015

Document obtained by CompleteColorado.com

Annual Limit Waiver Request Applicant Name

Phone Number (including area code) (xxx-xxxxxx)

Email Address

Type of Coverage (e.g., Limited Benefit, HRA, Rx only, Other)

SelfInsured

Total Number of Individuals Covered by Policy (include all Current Plan Individual or dependents Annual Limit covered) (in dollars) Group Policy

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Group

Ambulatory
Ex. 4

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Yes

Plumbers and Pipefitters Local Union 344

405-6824581

andrea@pp3 44.com Limited Benefit

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Plumbers L344:000016

Document obtained by CompleteColorado.com

Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)

Annual Limit Waiver Request Applicant Name

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Maternity/ Newborn

Emergency

Hospitalization

Laboratory

Pediatric

Mental Health/ Substance Abuse

Rehabilitative/ Devices
Ex. 4

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Plumbers and Pipefitters Local Union 344

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Plumbers L344:000017

Document obtained by CompleteColorado.com

Office Visit Copays/Coinsurance

Hospital Inpatient Copay/Coinsurance

Emergency Room Copay/Coinsurance

Rx Copay

Annual Limit Waiver Request Applicant Name

Preventive/ Wellness

Prescription

Coinsura Coinsura nce (if Copay (if nce (if Copay (if Copay (if Coinsuranc Copay (if Plan applicable e (if applicable applicable applicable applicable applicable ) ) ) ) Deductible ) applicable) )
Ex. 4

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Plumbers and Pipefitters Local Union 344

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Plumbers L344:000018

Document obtained by CompleteColorado.com

y/Coinsurance

Current Monthly Premium Rates or Premium Equivalent Rates (in dollars)*:

Renewal Monthly Premium Rates or Premium Equivalent Rates if Waiver Granted (in dollars)*

Annual Limit Waiver Request Applicant Coinsurance Name (if applicable)
Ex. 4

Individual/ Employee Tier*

Employee contribution

Employer contribution

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Total Employee contribution

Employer contribution

Total
Ex. 4

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Plumbers and Pipefitters Local Union 344

Employee + Family

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Plumbers L344:000019

Document obtained by CompleteColorado.com

Projected Rate Increase that would result from compliance with $750,000 Annual Limit Restriction (in dollars) (Average Premium by Individual)*

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Ex. 4

Annual Limit Waiver Request Applicant Name

Employee contribution

Employer contribution

Total

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Plumbers and Pipefitters Local Union 344

Decrease in Access to Benefits that would result Projected Rate Increase from that would result from compliance with $750,000 compliance Annual Limit Restriction (in with $750,000 dollars)(Average Premium Annual Limit Restriction by Individual) (Difference (describe of Column AV and AS briefly) divided by Column AS) Compliance with the regulation would result in a significant decrease in access to

Plan Administr ator/ CEO of Health Insurance Issuer Name

Title of Individual Providing Attestation

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Darren Jones

Plan Administrator

Plumbers L344:000020

Document obtained by CompleteColorado.com

Annual Limit Waiver Request Applicant Name

Taft-Hartley Plan

If Yes TaftHartley then Date Collective Bargaining Agreement Expires

Compliance with Grandfather Regulation

Lead Reviewer

Yes

06/30/2012

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Plumbers and Pipefitters Local Union 344

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No K. Scelzo 11/29/2010

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Date of Receipt

Factor 1 for Decision

6: The number of enrollees under the plan seeking the waiver.

Plumbers L344:000021

Document obtained by CompleteColorado.com

OCIIO Reviewer

Annual Limit Waiver Request Applicant Name

Factor 2 for Decision

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Plumbers and Pipefitters Local Union 344

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Factor 3 for Decision
Plumbers L344:000022

Document obtained by CompleteColorado.com

Annual Limit Waiver Request Applicant Name

Factor 4 for Decision

OCIIO Staff Recommend ation for Approval/ Disapproval

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Comments Cam's Applicant

Date of Completed Final Application Decision

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Plumbers and Pipefitters Local Union 344

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Deny

01/11/2011

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Plumbers L344:000023

Document obtained by CompleteColorado.com

Final Decision and Correspondence

Annual Limit Waiver Request Applicant Decision Name Date

Date of Waiver

Approval/ Disappro val Letter Sent Y/N

Date of Letter

Confirmat ion of Receipt of Approval

Access File

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Plumbers and Pipefitters Local Union 344

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Plumbers L344:000024

From: Botwinick, Alexandra (HHS/OCIIO) Sent: Monday, January 31, 2011 9:19 AM To: '[email protected]' Cc: Habit, Sandra (HHS/OCIIO) Subject: Plumbers and Pipefitters Local Union 344 Waiver of the Annual Limits Requirements 1-31-2011 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Good Morning,   Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Plumbers and Pipefitters Local Union 344.  HHS has reviewed your application and made its determination. Please see the attached letter.   Please confirm receipt of this letter by replying to this e-mail.   Please let me know if I can be of further assistance.
 

Document obtained by CompleteColorado.com

     

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Plumbers L344:000025

Alexandra Botwinick   Office of Oversight HHS/OCIIO

[email protected]

file:///C|/...IA%20-%20Second%20Round/Disc%202/Plumbers%20&%20Pipefitters%20Local%20Union%20344/Approval%201.31.11.htm[08/23/2011 3:57:11 PM]

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Document obtained by CompleteColorado.com

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Plumbers L344:000026

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Document obtained by CompleteColorado.com

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Plumbers L344:000027

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