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Change in Status Election Form Section 125 Cafeteria Plan Year December 1, 2013, through November 30, 2014Employee Name: Employee Number: As a participant in the Cafeteria Plan, I am entitled to revoke
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Obtain the necessary change in status election form from your election office or download it from their website.
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Read the instructions provided with the form carefully to ensure you understand the requirements and necessary documentation.
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Complete all sections of the form, providing accurate and up-to-date information.
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Attach any required supporting documentation, such as proof of residency or identification, as specified by the election office.
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Submit the filled-out form to the election office by the specified deadline, either in person, by mail, or through any approved electronic means.
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Who needs change in status election?

01
Anyone who wishes to update their status for an upcoming election needs to fill out a change of status election form. This may include individuals who have changed their address, name, party affiliation, or any other information that affects their eligibility to vote or participate in the election process. It is important to check with the specific election office or authorities to determine the exact requirements and eligibility criteria for a change in status election.
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A change in status election is a formal process that allows individuals to modify their benefits elections based on certain qualifying life events, such as marriage, divorce, birth of a child, or change in employment status.
Employees who experience a qualifying life event that affects their benefits choices are required to file a change in status election.
To fill out a change in status election, an individual usually needs to complete a specific form provided by their employer or benefits administrator, detailing the nature of the qualifying event and the desired changes in benefits.
The purpose of a change in status election is to ensure that individuals can adjust their health and welfare benefits to reflect significant changes in their personal circumstances.
Information that must be reported typically includes the type of qualifying event, the date of the event, and any changes in coverage or elections being requested.
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