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This document is used by employees to declare their health coverage enrollment status and make choices regarding their eligibility for health benefits under the CalPERS program.
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How to fill out HB-12A

01
Obtain the HB-12A form from the relevant agency or website.
02
Read the instructions carefully to understand the requirements.
03
Fill out personal information: Name, address, and contact details in the designated fields.
04
Provide information related to the specific purpose of the HB-12A application.
05
Attach any required documentation that supports your request.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form as required.
08
Submit the finished form according to the provided instructions (online, by mail, or in person).

Who needs HB-12A?

01
Individuals or organizations applying for a specific permit or license.
02
Those seeking to report information related to a certain activity or status.
03
Applicants who are required to submit documentation for compliance purposes.
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It's “alive and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart” (Hebrews 4:12). The words of Scripture are given for the moments when we need direction, correction and training.
Hebrews 4:12 New Century Version (NCV) God's word is alive and working and is sharper than a double-edged sword. It cuts all the way into us, where the soul and the spirit are joined, to the center of our joints and bones. And it judges the thoughts and feelings in our hearts.
For the word of God is quick, and powerful, and sharper than any twoedged sword, piercing even to the dividing asunder of soul and spirit, and of the joints and marrow, and is a discerner of the thoughts and intents of the heart.
Hebrews also compares God's Word to a sharp sword, or perhaps we should say a scalpel, because it cuts open and lays bare the secrets of the heart. The Bible is an instrument of discernment. It can separate truth from falsehood, wheat from chaff, real from phony.
ESV For the word of God is living and active, sharper than any two-edged sword, piercing to the division of soul and of spirit, of joints and of marrow, and discerning the thoughts and intentions of the heart. NIV For the word of God is alive and active.
For the word of God is alive and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart.

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HB-12A is a form used for reporting specific financial information required by certain regulatory bodies. It is typically related to reporting business activities or income.
Entities or individuals who meet certain financial thresholds or operate in specific industries are required to file HB-12A. This often includes businesses and self-employed individuals.
To fill out HB-12A, you must provide the required financial data, including income details, expenses, and other relevant financial information as specified in the form's instructions.
The purpose of HB-12A is to ensure transparency and compliance with financial regulations by requiring entities to disclose their financial activities and status.
The information that must be reported on HB-12A typically includes total income, deductions, business expenses, and other relevant financial data depending on the jurisdiction and specific requirements of the form.
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