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How to use or fill out ps 404 with our platform
- Click ‘Get Form’ to open the PS-404 in the editor.
- Begin by filling out the Employee Information section (Boxes 1-11). Provide your last name, first name, social security number, sex, and contact details. Ensure accuracy as this information is crucial for processing your request.
- In the Elect or Decline Coverage section (Box 12), select your preferred coverage options. You can choose between Pre-Tax and After-Tax deductions for medical coverage. Make sure to check the appropriate boxes for individual or family enrollment.
- If you need to change or cancel existing coverage (Box 13), indicate the reason and provide any necessary details regarding qualifying events such as marriage or divorce.
- Complete the Dependent Information section (Box 14) if enrolling dependents. Check whether you are adding, deleting, or changing a dependent's information and provide their details.
- Finally, ensure you sign and date the form in the Authorization section to validate your submission.
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See more ps 404 versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.8 Satisfied (221 Votes) | |
| 2019 | 4.3 Satisfied (52 Votes) | |
| 2017 | 4.2 Satisfied (78 Votes) | |
| 2017 | 4.4 Satisfied (129 Votes) | |
| 2014 | 4.3 Satisfied (76 Votes) | |
| 2011 | 4.8 Satisfied (49 Votes) | |
| 2007 | 4.6 Satisfied (43 Votes) | |
| 2006 | 4 Satisfied (54 Votes) | |
| 2001 | 4.1 Satisfied (28 Votes) |
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