Get Ca Form Cc 0170 2000-2025

Completing the CA Form CC 0170 online is a straightforward process designed to help users submit a new hire enrollment quote request efficiently. This guide provides step-by-step instructions to ensure you can fill out the form accurately and easily.

Follow the steps to complete the CA Form CC 0170 online.

1. Select the ‘Get Form’ button to access the CA Form CC 0170 and open it in the designated editor.
2. Enter the date of the request in the designated field at the top of the form.
3. Fill in the name of the requestor, ensuring you include the correct spelling.
4. Provide the telephone number, including the area code, for the requestor's contact.
5. Input the CaliforniaChoice group number as required.
6. Enter the employer name in the specific section provided.
7. For employee information, input the group effective date in the designated field.
8. Complete the employee's last name, birth date (month, day, year), first name, and middle initial.
9. Include the employee's residence zip code and city.
10. Select the employee's gender by checking the appropriate box.
11. Fill in the hire date of the employee in the required format.
12. Indicate the rates to be shown before and after employer contribution as necessary.
13. Repeat the employee information steps for any additional employees, if applicable.
14. In the delivery instructions section, provide the name and mailing address where materials should be sent.
15. Enter the city, state, and zip code for the mailing address.
16. Provide the broker's telephone number, including area code.
17. Review all information entered for accuracy before saving.
18. Finally, save your changes, download, print, or share the form as needed.

Start filling out your CA Form CC 0170 online today to streamline your hiring process.