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BENEFITS ENROLLMENT/CHANGE WORKSHEET This worksheet is needed to initiate enrollment or make changes to your health benefits. This form must be received in Human Resources within 60 days from your
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This worksheet is needed to gather and organize specific information.
Individuals or entities designated by the governing body.
The worksheet can be filled out manually or electronically, following the instructions provided.
The purpose of this worksheet is to ensure accurate reporting and compliance with regulations.
Specific details as outlined in the instructions must be reported on this worksheet.
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