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EMPLOYER SHARED RESPONSBILITY PAYMENT (ESRP)

A tax penalty assessed by the IRS on Applicable Large Employers that don’t offer affordable health care that provides minimum value to their employees.

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First Name

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Last Name

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Email Address

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Agency Name / Organization

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Your Job Title

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State

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# of Employees

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Phone Number X (XXX) XXX-XXXX

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EMPLOYER SHARED RESPONSBILITY PAYMENT (ESRP)

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