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COUNTY OF SANTA CRUZ AMENDED AND RESTATED D-CARE: DEPENDENT CARE REIMBURSEMENT PROGRAM 2011 ENROLLMENT FORM Annual Enrollment Required I hereby elect to participate in the County of Santa Cruz (County)

How to fill out 2011 d-care enrollment formdoc

How to fill out 2011 d-care enrollment formdoc:

1. Obtain a copy of the 2011 d-care enrollment formdoc. This form can usually be found on the website of the organization that provides d-care services.
2. Carefully read all instructions provided with the form. This will help you understand the purpose of the form and ensure that you fill it out correctly.
3. Start filling out the form by providing your personal information. This typically includes your full name, date of birth, address, contact information, and social security number.
4. Next, indicate your desired coverage period. Specify the start and end dates for the coverage you are seeking.
5. Provide information about your current health insurance coverage, if any. This may include the name of your current insurance provider, policy number, and the dates of coverage.
6. Indicate your dependents, if applicable. Include their full names, dates of birth, and relationship to you.
7. Specify the type of d-care services you are interested in. This may include medical, dental, vision, or other services. Be sure to indicate your preferred providers, if any.
8. Review all the information you have entered to ensure accuracy and completeness. Make any necessary corrections before submitting the form.
9. Sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.
10. Keep a copy of the completed form for your records.

Who needs 2011 d-care enrollment formdoc:

1. Individuals who are interested in enrolling in d-care services for the year 2011.
2. Those who want to update their existing d-care coverage for the year 2011.
3. Individuals who currently have no health insurance coverage and wish to enroll in d-care services for the year 2011.

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What is d-care enrollment formdoc?

The d-care enrollment formdoc is a document used for enrolling in a specific health care program.

Who is required to file d-care enrollment formdoc?

Anyone who wishes to enroll in the d-care health care program must file the enrollment form.

How to fill out d-care enrollment formdoc?

You can fill out the d-care enrollment formdoc by providing accurate information about yourself and following the instructions on the form.

What is the purpose of d-care enrollment formdoc?

The purpose of the d-care enrollment formdoc is to gather information about individuals enrolling in the d-care health care program.

What information must be reported on d-care enrollment formdoc?

The d-care enrollment formdoc typically requires personal information, contact details, and any relevant health information.