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FOR LIB USE Uniform LG04 Revised 7/17LOCAL GOVERNMENT HEALTH INSURANCE PROGRAM 2018 DECLINATION OF COVERAGE Format: Initials: SUBSCRIBER INFORMATION (Please print or type.) Name (First, Middle Initial,
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What is for lghib use only?
For LGHIB use only is a designation that indicates a form or document is intended for internal use only by the LGHIB (Local Government Health Insurance Board).
Who is required to file for lghib use only?
Only authorized personnel within the LGHIB are required to file forms or documents with the designation for LGHIB use only.
How to fill out for lghib use only?
To fill out for LGHIB use only, ensure that the form or document is marked clearly with the designation and restrict access to authorized LGHIB personnel only.
What is the purpose of for lghib use only?
The purpose of for LGHIB use only is to maintain confidentiality of certain information and restrict access to authorized LGHIB personnel for internal use only.
What information must be reported on for lghib use only?
Confidential or sensitive information that is relevant to the operations of the LGHIB may be reported on forms or documents with the designation for LGHIB use only.
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