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STATE OF CALIFORNIAEdmund G. Brown Jr., GovernorDEPARTMENT OF MANAGED HEALTH CARE Shelley Robillard, Director 980 Ninth Street, Suite 500 Sacramento, CA 95814California Rate Filing Former Individual

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To fill out a state of California department form, follow these steps: 1. Obtain the necessary form from the department's website or office. 2. Read the instructions carefully to understand the requirements and any supporting documents needed. 3. Gather all the necessary information and documents before starting. 4. Begin by providing your personal details, such as name, date of birth, and contact information. 5. Fill in the required fields and sections of the form, ensuring accuracy and completeness. 6. If any section does not apply to you, indicate 'N/A' or 'Not Applicable.' 7. Double-check all the entered information for any errors or missing details. 8. Attach any supporting documents as specified by the form's instructions. 9. Sign and date the form where indicated. 10. Review the completed form one more time to ensure everything is accurate and complete. 11. Make a copy of the filled-out form and all supporting documents for your records. 12. Submit the form either by mail or in person to the designated department address or office.

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The State of California Department refers to various state agencies responsible for implementing laws, regulations, and services in California, such as the California Department of Tax and Fee Administration (CDTFA), which oversees sales tax, fuel tax, and other taxes.

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