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How to use or fill out nys ps 404 form with DocHub
- Click ‘Get Form’ to open the NYS PS 404 form in our editor.
- Begin by filling out the Employee Information section. Enter your first name, middle initial, last name, social security number, sex, date of birth, and contact details including your street address and telephone numbers.
- Indicate your marital status by checking the appropriate box. If applicable, provide information regarding Medicare coverage.
- In the Request Enrollment section, select whether you are requesting individual or family enrollment. Choose your medical plan (Empire Plan or HMO) and complete any additional fields as necessary.
- If you have dependents, fill out the Dependent Information section carefully. Indicate whether you are adding, deleting, or changing coverage for each dependent.
- Review all entries for accuracy before signing at the bottom of the form to authorize deductions from your salary for insurance.
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See more nys ps 404 form 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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