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20222023 EMPLOYEE SEASON PASS APPLICATION Employees is working 16 or more hours per week. Check here if this employee is a Volunteer. Employee is working less than 16 hours per week. Managers Signature:
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Gather all necessary information regarding benefits that are being impacted.
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Determine the reason or cause for the impact on benefits.
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Contact the appropriate benefits provider or HR department for guidance on how to proceed.
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Make any necessary changes or updates to ensure benefits are being impacted in the correct manner.
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Monitor the situation and follow up as needed to address any further impacts on benefits.

Who needs how are benefits impacted?

01
Employees who are experiencing changes in their benefits package.
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Employers who are implementing changes to employee benefits.
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Benefit administrators who need to communicate and manage the impact of benefit changes.
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Benefits can be impacted based on changes in income, employment status, or eligibility requirements.
Individuals receiving benefits or those responsible for managing benefits may be required to file.
You can fill out the form online, by mail, or in person at a designated office.
The purpose is to ensure that beneficiaries are receiving the correct amount of benefits based on their current circumstances.
You must report any changes in income, employment status, household composition, or other relevant details.
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