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Penalty Community College District Flexible Benefits Plan Enrollment Form January 1, 2010-December 31, 2010 If you wish to participate in any portion of the flexible benefit plan you must complete
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Year Started With Employer: Employer Address: Employer Phone: Employer City: Employer State: Employer Zip Code: DATE YOU STARTED WORKING FOR THE EMPLOYER: MONTH OF THE YEAR YOU STARTED WORKING FOR THE EMPLOYER: IF YOUR NUMBER NOT AVAILABLE TO ENSURE YOU ARE ACCEPTING A PLAN TO COMPETE With this information provided you will provide the Division with your Social Security information and a new Form 1095-C. The Division will then request you to complete a new 1095-C. If you elect to participate in the Social Security and Medicare flexible benefit option, you will no longer need to provide the Employer Address, Employer Phone, and Employer City information that you included on your first 1095-C. However, we welcome your continued participation in the Employer Address, Employer Phone, and Employer City information on your new Form 1095-C. YOU CAN DISCONNECT YOUR EMPLOYER E-MAIL IF YOU DID NOT CHOOSE THE 1095-C AND/OR YOUR E-MAIL SENT AS AN AUTOMATIC ENTRY. In doing so, you may remove your employer address from your records, including your Form 1094-C. However, you are required to continue to maintain your employer addresses on any Form 1095-C's you submit. Please note that you must provide us with a valid Social Security Number and your first 1095-C. If you do not provide these documents, we will request a new 1095-C. If you have any questions please call us at or email us. If you are enrolled as both an enrolled employee and a retiree: Name: SSN: Home Phone: Street Address: City: State: Zip Code: DOB. Year Started With Employer: Employer Address: Employer Phone: Employer City: Employer State: Employer Zip code: DATE YOU STARTED WORKING FOR THE EMPLOYER: MONTH OF THE YEAR YOU STARTED WORKING FOR THE EMPLOYER: If Your Number Not AVAILABLE TO ENSURE YOU ARE ACCEPTING A PLAN TO COMPETE With this information provided you will provide the Division with your Social Security information and a new Form 1095-C. The Division will then request you to complete a new 1095-C.

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Peralta Community College District is a public community college district in Alameda County, California. It consists of four community colleges: Berkeley City College, College of Alameda, Laney College, and Merritt College.
The Peralta Community College District is required to file its financial and operational information as mandated by the California Community Colleges Chancellor's Office, the California State Controller's Office, and other regulatory bodies.
To fill out the Peralta Community College District forms, the district administration, finance department, and other relevant departments must collect and compile the required financial information, operational data, and other reports. The completed forms must be submitted electronically or by mail as instructed by the regulatory authorities.
The purpose of the Peralta Community College District is to provide accessible, high-quality education and career training to a diverse student population. The district aims to promote social mobility, equity, and community development through its four community colleges.
The Peralta Community College District must report various financial information, including revenue and expenditure data, cash flows, balance sheets, and budgetary details. Additionally, operational information such as enrollment statistics, program outcomes, and demographic data of students may also be required to be reported.
The specific deadline to file the Peralta Community College District in 2023 may vary depending on the regulatory authorities and their designated submission timelines. It is advised to refer to the instructions provided by the California Community Colleges Chancellor's Office and the California State Controller's Office for the accurate deadline information.
The penalty for the late filing of the Peralta Community College District may vary based on the regulations and guidelines set by the regulatory authorities. It is advisable to consult the California Community Colleges Chancellor's Office, the California State Controller's Office, or other relevant bodies to obtain the specific penalty details.
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