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HRA New Group SetUp Form Company Information Company Name ___ Address City___ ___ State ___ Zip Code___Tax ID (VEIN) # ___ ___ Approximate Number of Insured Lives ___Min. Weekly Hrs. For Full Time
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This form is used for setting up a new group without a proposal and version 18 publication.
Any individual or organization looking to set up a new group without a proposal and version 18 publication is required to file this form.
The form must be completed with accurate information about the new group and its setup without a proposal and version 18 publication.
The purpose of this form is to officially establish a new group without a proposal and version 18 publication.
The form must include details about the new group, the reason for not having a proposal, and any relevant information about version 18 publication.
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