Get Employee Status Change Form- Medical.doc

This guide provides clear instructions on how to effectively complete the Employee Status Change Form- Medical.doc online. By following the steps outlined below, you will ensure that your changes are submitted accurately and in compliance with necessary procedures.

Follow the steps to complete and submit the form online.

1. Press the ‘Get Form’ button to access the Employee Status Change Form- Medical.doc and open it in your preferred editor.
2. Input the effective date for the change at the top of the form. This is essential for tracking when your requested changes will take effect.
3. Fill in your name and Social Security number in the designated fields to identify yourself clearly.
4. Enter the employer or sponsor's name along with the unit or division number associated with your employment.
5. Indicate the changes you wish to make in the 'Please make the following marked changes' section. Ensure you choose the appropriate reason for the change from the options provided.
6. If applicable, complete the 'Change of Name' section by adding your previous and new names.
7. In the 'Change of Coverage' section, indicate whether you want to add or remove dependents. For dependents being added, fill out their name, relationship, birthdate, and Social Security number.
8. If applicable, answer the question regarding stepchildren's residency and provide appropriate documentation if your application is submitted more than 30 days after a qualifying event like marriage or birth.
9. Complete the 'Change of Address' section, if necessary, by providing your previous and new addresses.
10. Sign and date the form in the designated sections to validate your request, and ensure to record the date when the administrator processes your request.
11. Once you have filled out the form, save your changes, and choose to download, print, or share the document as needed.

Complete your documents online today to ensure your status changes are processed efficiently.