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Member Reimbursement Claim Form Subscriber Information Subscriber Name Daytime Phone (Mailing Address City) Evening Phone (State) Zip Subscriber ID Number Name of Employer Patient Information Patient
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CALHR 774 is a form used by California state employees to report outside employment and income.
All California state employees who engage in outside employment or receive outside income are required to file CALHR 774.
To fill out CALHR 774, state employees must provide information about their outside employment, including the name of the employer, the nature of the employment, and the income received.
The purpose of CALHR 774 is to ensure transparency and prevent conflicts of interest by requiring California state employees to report their outside employment and income.
On CALHR 774, state employees must report the name of the employer, the nature of the employment, the amount of outside income received, and the number of hours worked per week for each outside employment.
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