Get the free 2012 Enrollment Correction Form - oregon

This form is used to request corrections to enrollment errors in core and optional plans for the 2012 plan year, particularly for state employees and their dependents under PEBB benefits.

How to fill out 2012 enrollment correction form

How to fill out 2012 Enrollment Correction Form

1. Obtain a copy of the 2012 Enrollment Correction Form from the official website or your employer's HR department.
2. Fill in your personal details, including your name, address, and Social Security number at the top of the form.
3. Provide the relevant enrollment information that needs correction, specifying the incorrect details clearly.
4. Attach any supporting documents or evidence that validate the correction, if necessary.
5. Review the entire form for accuracy and completeness before submitting.
6. Sign and date the form as required to certify the information is correct.
7. Submit the form to the designated office or department indicated in the instructions.

Who needs 2012 Enrollment Correction Form?

1. Individuals who made errors on their 2012 enrollment forms or need to update their personal information.
2. Employees who wish to correct their health insurance, retirement benefits, or other enrollment details for 2012.
3. Anyone who changes their eligibility or status affecting their enrollment and needs to notify the appropriate authorities.

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For pdfFiller’s FAQs

What is 2012 Enrollment Correction Form?

The 2012 Enrollment Correction Form is a document used to make adjustments or corrections to enrollment data submitted for the year 2012.

Who is required to file 2012 Enrollment Correction Form?

Individuals or organizations that have submitted incorrect enrollment information for the year 2012 are required to file the 2012 Enrollment Correction Form.

How to fill out 2012 Enrollment Correction Form?

To fill out the 2012 Enrollment Correction Form, obtain the correct version of the form, provide accurate details of the original enrollment, indicate the corrections being made, and submit the completed form as instructed.

What is the purpose of 2012 Enrollment Correction Form?

The purpose of the 2012 Enrollment Correction Form is to allow individuals or organizations to rectify any errors or discrepancies in their previously submitted enrollment information.

What information must be reported on 2012 Enrollment Correction Form?

The information that must be reported includes the original enrollment details, specific corrections required, and any supporting documentation to justify the changes.