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Print FormEMPLOYEE BENEFITS DIVISIONState of New York
Department of Civil Service
Albany, NY 12239NYS HEALTH INSURANCE TRANSACTION FORM
PS404 (10/06)INSTRUCTIONS: READ AND COMPLETE BOTH SIDES/PAGES.
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What is ps-404doc?
Ps-404doc is a form used for reporting changes to a company's status or structure to the authorities.
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Any company that undergoes changes to its status or structure is required to file ps-404doc.
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The purpose of ps-404doc is to keep the authorities informed of any changes in a company's status or structure.
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Ps-404doc requires information such as the company's name, address, changes in ownership, and other relevant details.
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