Get De 1378j.pdf

The DE 1378J form is an application for elective coverage by disability insurance, specifically for exempt family employees. This guide provides a clear, step-by-step process for completing the form online to ensure you can submit your application accurately and efficiently.

Follow the steps to complete the DE 1378J form online.

1. Click the ‘Get Form’ button to access the form and open it in the digital editor.
2. Begin by entering the required account number and statistical code in the fields provided. This information is necessary for processing your application.
3. Provide the effective date in the appropriate field, indicating when you wish the coverage to start.
4. Fill out the date the employer was notified about this application.
5. Complete the employer name and their social security number, followed by the business name and address. Ensure that the business address includes the street, city, state, and zip code.
6. Indicate your Employment Development Department account number(s), if applicable.
7. Select the nature of your business by checking one of the provided options such as retail trade, service, or other as applicable. You may also describe the product or service offered.
8. If you are a manufacturer, list the principal products in order of importance.
9. State the months during which your business operates if it is seasonal.
10. Answer if you expect to remain in business for the next eight calendar quarters.
11. Detail the services performed by exempt family employees.
12. Indicate whether you report to social security for exempt family employees, providing explanation if applicable.
13. Specify how many employees will be covered under this agreement and the number of business locations in California.
14. List the locations that will be covered by this application.
15. Indicate if deductions were made from employee wages for contributions and specify the date from which these deductions began.
16. Provide the desired start date for elective coverage.
17. Fill out the section regarding family members electing coverage, including their names, ages, relationships, social security numbers, and signatures.
18. Ensure each employee electing coverage has signed the form, whether additional space is needed or not.
19. Finally, certify that all the statements in the application are correct by signing and dating the form.
20. Once completed, you can save your changes, download the form, print a copy, or share it as needed.

Start completing the DE 1378J form online today to ensure your coverage is processed promptly.