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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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Ex. 4
Plumbers L344:000002
Document obtained by CompleteColorado.com
Ex. 4 Ex. 4
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Ex. 4
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Ex. 4 Ex. 4 Ex. 4
Plumbers L344:000003
Document obtained by CompleteColorado.com
Ex. 4
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Ex. 4 Ex. 4 Ex. 4
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Plumbers L344:000004
Document obtained by CompleteColorado.com
Ex. 4 Ex. 4
Ex. 4 Ex. 4
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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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