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Employee Enrollment / Change Form Initial GroupCOBRAOpen EnrollmentBenefits Administered by:New EmployeeChange (complete change section on reverse side) GROUP NUMBER UMR ENROLLMENT SERVICESEMPLOYER

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What is change complete change section?

Change complete change section is a section of a form or document where any changes or updates to the original information are recorded.

Who is required to file change complete change section?

The person or entity responsible for the form or document is required to file the change complete change section.

How to fill out change complete change section?

To fill out the change complete change section, one must carefully document any changes or updates to the original information in the designated fields.

What is the purpose of change complete change section?

The purpose of the change complete change section is to ensure that any updates or revisions to the original information are properly documented and recorded.

What information must be reported on change complete change section?

The change complete change section must report any changes or updates to the original information, including dates, names, and any other relevant details.

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