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Get Wa Dshs 14-252(x) 2007-2026
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How to fill out the WA DSHS 14-252(X) online
Filling out the WA DSHS 14-252(X) form online is a straightforward process that requires attention to detail. This guide will provide you with step-by-step instructions to help you complete each section effectively.
Follow the steps to accurately complete the WA DSHS 14-252(X) form.
- Press the ‘Get Form’ button to access the form and open it in the editor.
- Begin by filling out Section 1 as the client/employee. Provide your authorization for your employer to release information to the Department of Social and Health Services and sign the form.
- In Section 2, the employer will need to input the employee’s name, employer’s name, and address.
- Indicate whether this is a new job and the date the employee started work, if applicable.
- Provide the average hours the employee works per week and the pay frequency (daily, weekly, bi-weekly, or monthly).
- Fill in the rate of pay or salary and specify whether the job is Work Study, including the date the first check was received.
- Answer if the job has ended and, if so, provide the date. If the job is ending, indicate when.
- Record the actual gross income for the last three months, and for the current month along with anticipated gross income for the next two months.
- Next, address any additional compensation such as tips, commissions, bonuses, and overtime, specifying amounts and frequency.
- Outline the work schedule by listing the employee’s hours for each day of the week.
- Confirm if health insurance is available and whether the employee is enrolled in the plan. Include the date coverage begins and the employee’s portion of premiums.
- Have the employer representative sign and date the form, and provide their printed name and title, as well as a contact phone number.
- Once all sections are complete, save your changes, download, print, or share the form as required.
Complete your WA DSHS 14-252(X) form online today for a smooth processing experience.
To send a fax to DSHS in Washington state, you will need to obtain the appropriate fax number based on the department handling your case. Make sure to include your case number and any required forms as per WA DSHS 14-252(X). Always keep a copy of your fax transmission report as proof of submission.
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