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Form LG02BLOCAL GOVERNMENT HEALTH INSURANCE PROGRAM 2022 NEW DEPENDENT FORMRevised 10/21PARTICIPANT INFORMATION (Please print or type.) Name (First, Middle Initial, Last) Social Security Numerate
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Indicate the type of local government you are affiliated with or representing.
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Form LG02-B is a reporting form used by local governments to disclose financial information.
Local governments are required to file form LG02-B.
Form LG02-B must be completed by providing accurate financial information as instructed on the form.
The purpose of form LG02-B is to provide transparency and accountability regarding the financial activities of local governments.
Form LG02-B requires reporting of financial transactions, revenues, expenditures, and balances.
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