Get Dlir Shop Eligibility Form B2016b - Department Of Labor And Bb

Completing the DLIR SHOP Eligibility Form B2016b is an essential step for qualified employers seeking to participate in the Small-Business Health Options Program (SHOP). This guide provides clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the number of full-time equivalent employees currently in your company. Refer to the federal calculator if needed.
3. Indicate the expected percentage of the employee premium that your company will contribute by selecting one of the provided options – 100%, Prepaid Health Care compliance, or other.
4. Certify that your company meets the eligibility criteria to participate in SHOP by confirming each statement regarding employee coverage and business location.
5. Print your name and title in the designated fields, confirming your status as an authorized representative of the company.
6. Signed the form where required, ensuring you also include the date and your company’s address and EIN.
7. Review all information for accuracy. Once satisfied, save your changes, and you may choose to download or print the completed form.

Complete your DLIR SHOP Eligibility Form B2016b online today to ensure your business can take advantage of available health coverage options.