Get Enrollmentchange Form - Carpenterssworg

Completing the ENROLLMENTCHANGE FORM allows users to update their enrollment status, add dependents, or report changes in personal information. This guide provides step-by-step instructions for accurately filling out the form online, ensuring a smooth process for all users.

Follow the steps to effectively complete the enrollment/change form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by indicating the effective date of the change. Fill in the date in the spaces provided.
3. Choose one option by marking the appropriate checkbox: new enrollment, new social security number/name change, employee ID number, facility change, address change, add dependent, or remove dependent.
4. If applicable, specify the qualifying date related to any listed changes.
5. Complete the personal information section, including mailing address, date of birth, and social security number.
6. For dependent information, list each dependent’s name, date of birth, and select their gender by checking the appropriate box.
7. Designate each dependent’s relationship code using the provided codes such as SP for spouse or CH for child.
8. Fill out the signature field as the primary enrollee, including the date of signing.
9. Review all entered information for accuracy. Once completed, you can save changes, download, print, or share the form.

Complete your enrollment/change form online today to ensure your information is current.