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THIS FORM MUST BE SUBMITTED VIA MOVE IT. MOVE IT SUBMISSION INSTRUCTIONS ARE NOTED BELOW.CALIFORNIA STATE UNIVERSITY, FRESNO HEALTH BENEFITS WORKSHEET FAMILY STATUS CHANGE Rev 1/2022This document
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This form is the official document used by Fresno State's Administration and Finance department for HR benefits purposes.
All employees at Fresno State who are eligible for HR benefits are required to file this form.
To fill out this form, employees must provide accurate and up-to-date information regarding their HR benefits preferences.
The purpose of this form is to ensure that employees receive the HR benefits they are entitled to and that the Administration and Finance department has the necessary information to process these benefits.
Employees must report their preferences for health insurance, retirement plans, and other HR benefits on this form.
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