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Retiree Medical & Dental Enrollment and Change Form Action requested due to: (check all that apply) RetirementUtilizing One Time Reentry RightReemployed Retiree Terminating Active EmploymentCancelling
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Who needs utilizing one time re-entry?

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Utilizing one time re-entry may be needed by individuals who require temporary permission to leave a country or jurisdiction and return within a specified period.
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Utilizing one time re-entry refers to a process allowing individuals or entities to re-enter a specific status or program for a single occasion after previously being excluded or having exited.
Typically, individuals or businesses who have previously participated in a program but need to re-establish their status must file for one time re-entry.
To fill out the one time re-entry application, follow the specified guidelines, provide necessary personal or business information, and submit any required documentation as outlined in the application instructions.
The purpose of utilizing one time re-entry is to provide an opportunity for individuals or entities to regain access to a program or benefits that they previously qualified for but lost or exited from.
Information that must be reported typically includes personal identification details, reason for prior exit, current status, and any supporting documents that justify the request for re-entry.
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