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EMPIRE PLAN REPORT May 2013 New York State Health Insurance Program (SHIP) for Employees of the State of New York represented by District Council 37 (DC37), their enrolled Dependents, COBRA Enrolled
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To fill out the form for employees:

01
Start by gathering all the necessary information you will need to complete the form. This may include personal details such as the employee's full name, address, social security number, and date of birth.
02
Carefully read through the form instructions to ensure you understand the requirements and any specific guidelines provided. Pay attention to any deadlines or additional documentation that may be required.
03
Begin filling out the form by entering the employee's personal information accurately and clearly. Double-check the spelling of their name and ensure that all the provided details are correct.
04
If there are specific sections or questions that you are unsure about, seek clarification from your supervisor or the appropriate department to ensure accurate completion of the form.
05
Provide any necessary supporting documentation or attachments, if required. This may include copies of identification documents, tax forms, or employment-related documents. Ensure that these attachments are securely attached or properly submitted along with the form.
06
Review the completed form for any errors or omissions before submitting it. Take the time to carefully proofread all the entered details to ensure accuracy and completeness.
07
Once you are satisfied with the completed form, sign and date it as required. Additionally, if there are any sections that require the employee's signature or acknowledgment, make sure those are properly completed too.

Who needs the form for employees?

01
Employers or HR departments: The form is typically required by employers or HR departments to gather necessary information about their employees. It helps them maintain accurate records and meet legal requirements.
02
Employees: Employees may need to fill out this form to provide their personal information, tax information, or other employment-related details to their employer or HR department.
03
Government agencies: Depending on the jurisdiction, government agencies or tax authorities may require certain information from employers regarding their employees in order to ensure compliance with employment and tax laws.
It is important to note that the specific requirements and purposes of the form may vary depending on the country, jurisdiction, and organization. Therefore, it is advisable to consult with the relevant authorities or seek guidance from your employer or HR department for accurate and up-to-date information on filling out the form for employees.
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