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OPEN ENROLLMENT FORM SUBMIT THIS FORM TO HUMAN RESOURCES BY OCTOBER 19, 2018, ALLOW 10 DAYS FOR COUNTY & VENDOR PROCESSING. CHANGES ARE EFFECTIVE JANUARY 1, 2019. Date: San Benito County Human Resources
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Submit this form to the appropriate government agency or department.
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The information required to be reported varies depending on the form and the government agency or department.
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