Get the free Benefits Change Form 1-05.pmd - City of Colorado Springs

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OFFICE USE ONLY BENEFITS CHANGE FORM EMPLOYEE NAME (LAST) (FIRST) (MI) SOCIAL SECURITY # EMPLOYEE ID# WORK STATUS FULL TIME IF YOU HAVE MOVED SINCE LAST FILING FOR BENEFITS PLEASE ENTER NEW ADDRESS

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What is benefits change form 1-05pmd?

The benefits change form 1-05pmd is a document used to request changes to an individual's benefits information.

Who is required to file benefits change form 1-05pmd?

Any individual who needs to make changes to their benefits information is required to file the benefits change form 1-05pmd.

How to fill out benefits change form 1-05pmd?

To fill out the benefits change form 1-05pmd, you need to provide the requested personal and benefits information in the specified fields on the form.

What is the purpose of benefits change form 1-05pmd?

The purpose of the benefits change form 1-05pmd is to facilitate the process of updating and modifying an individual's benefits information.

What information must be reported on benefits change form 1-05pmd?

The benefits change form 1-05pmd requires the individual to report relevant personal details, such as name, address, and employee ID, as well as the specific changes they wish to make to their benefits information.

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