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Adobe PDF Adobe PDF document  Annual Deductible Re-Assessment Request – For Program Year 2021/22 Based on 2021 or 2022 IncomeThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print1386.0 kb
Adobe PDF Adobe PDF document  Annual Deductible Re-Assessment Request – For Program Year 2020/21 Based on 2020 or 2021 IncomeThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill & Print1388.0 kb

Form Classification
Classification / Identification:
 Form Number:014-4931-87EEdition date: 2021/07 
 Title:Annual Deductible Re-Assessment Request
 Ministry:Health  
 Branch/ABC:Drug Programs Delivery Branch  
 Program:Ontario Drug Benefit  
 Purpose of Form:MOHLTC form for Trillium Drug Program (TDP) Households to request a re-assessment of their TDP Household's deductible.  

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