Get Calhr 774

Filling out the Calhr 774 form is a necessary step for employees seeking to enroll in the Premier Vision Plan. This guide will provide clear and supportive instructions for completing the form online.

Follow the steps to successfully complete your Calhr 774 form.

1. Press the ‘Get Form’ button to acquire the form and display it in the online editor.
2. In section A, input your employee information. Provide your first name, middle initial, last name, social security number, mailing address, city, state, and zip code. Additionally, include your date of birth, email address, and telephone number.
3. In section B, indicate your enrollment election. Select your type of action: 'New Enrollment', 'Change', 'Cobra', or 'Cancel'. As a statement of your intent to enroll, acknowledge the authorization for deduction from your wages for the cost of the vision plan.
4. Read the terms of enrollment carefully. If you agree, sign with your name and date the form in the designated areas.
5. For section C, if you are enrolling dependents, input their information such as names, relationships, social security numbers, and dates of birth. Select whether to 'Add' or 'Delete' dependents accordingly.
6. In section D, leave this part for the employing agency’s use. Ensure all information is accurately completed.
7. Once all sections are completed, you can save changes, download, print, or share the final document.

Complete your Calhr 774 form online today to ensure your enrollment in the Premier Vision Plan.