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Get CA STD. 692 2012

S Act of 1977 (Civil Code Section 1798.17) and the Federal Privacy Act (Public Law 93-579) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the State Controller's Office and the dental insurance company for the purposes of identification and dental coverage processing. It is mandatory to furnish all information requested on this form except for employee's gender and marital status, which may be furnished on .

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