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How to use or fill out Form 3460 CA PMD - countyofsb with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the 'Primary Enrollee Information' section. Enter your Social Security Number, First Name, Last Name, and Mailing Address. Ensure all details are accurate for processing.
- Next, indicate any changes such as Address Change, Add/Delete Dependent, or Terminate Enrollee Coverage by checking the appropriate boxes.
- In the 'Dependent Information' section, provide details for each dependent you wish to enroll or terminate. Include their names, Social Security Numbers, and Dates of Birth.
- Review your entries carefully. Once satisfied, sign and date the form at the bottom to authorize any necessary payroll deductions.
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