Get Kaiser Permanente 3190 Cal 2012-2025

Filling out the Kaiser Permanente 3190 CAL is an important step in registering a domestic partnership for benefits enrollment. This guide will provide clear, step-by-step instructions to help users complete the form accurately and confidently.

Follow the steps to complete the Kaiser Permanente 3190 CAL form.

1. Click ‘Get Form’ button to obtain the form and open it for editing. This will allow you to fill out the necessary information electronically.
2. Begin by reviewing the instructions carefully. You can either complete the form online and print it or print it beforehand and fill it out using blue or black ink.
3. Provide your Employee ID and contact phone number in the required fields. Remember, items marked with an asterisk (*) are mandatory.
4. Enter the effective date, which is the date you and your domestic partner entered into the domestic partnership relationship.
5. Complete the personal information section by including your first name, middle name (if applicable), and last name.
6. In the domestic partner section, select whether you have registered your relationship with a local or state government domestic partner registry. If registered, attach a copy of your certified registration.
7. Continue filling out the form, providing the names and details of your domestic partner and any children involved. Make sure to indicate whether each person is a legal tax dependent.
8. Review the acknowledgment of understanding section regarding the domestic partner and any children, ensuring you meet the necessary criteria outlined.
9. Once all sections are completed, review your entries for accuracy, then sign and date the form as the employee and have your domestic partner sign as well.
10. When complete, ensure you retain a copy for your records. Then, fax the form to the provided HR Service Center number as specified.

Start filling out your Kaiser Permanente 3190 CAL form online today to ensure your domestic partner receives the benefits they deserve.