Get the free 16-17 Benefit Change Form - City of Scottsdale - scottsdaleaz

CITY OF SCOTTSDALE 2016/2017 BENEFITS ENROLLMENT/CHANGE FORM New Enrollment Open Enrollment Qualifying Event: Change in Enrollment Qualifying Event Date & Effective Date: Dependent change Termination

How to fill out 16-17 benefit change form

How to fill out 16-17 benefit change form:

1. Start by carefully reading the instructions provided on the form. This will give you a clear understanding of the information you need to provide and any supporting documentation required.
2. Fill in your personal details accurately. This typically includes your name, contact information, and social security number.
3. Provide information about your current benefits. Indicate the type of benefit you are currently receiving and any changes you wish to make.
4. If there are any changes in your family status or financial situation, make sure to provide updated information. This may include changes in income, household members, or medical conditions.
5. Review the form for completeness and accuracy before submitting it. Double-check all the information you have entered to ensure it is correct.
6. If required, attach any supporting documentation that is requested. This may include proof of income, marriage certificate, birth certificate, or medical records.
7. Sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.

Who needs 16-17 benefit change form:

1. Individuals who are receiving benefits and wish to make changes to their current benefits, such as updating personal information, income changes, or changes in family status.
2. Individuals who have experienced a change in their financial situation and need to update their benefits accordingly.
3. Individuals who have had changes in their family status, such as getting married, divorced, or having a child, and need to adjust their benefits accordingly.

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What is 16-17 benefit change form?

The 16-17 benefit change form is a form used to request changes to benefits for the year 2016-2017.

Who is required to file 16-17 benefit change form?

Employees who wish to make changes to their benefits for the year 2016-2017 are required to file the 16-17 benefit change form.

How to fill out 16-17 benefit change form?

To fill out the 16-17 benefit change form, employees need to provide their personal information, current benefits information, and the changes they want to make.

What is the purpose of 16-17 benefit change form?

The purpose of the 16-17 benefit change form is to allow employees to make changes to their benefits for the year 2016-2017.

What information must be reported on 16-17 benefit change form?

Employees must report their personal information, current benefits selection, and the changes they wish to make on the 16-17 benefit change form.