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Employer Questionnaire Rev doc

Employer Questionnaire Rev doc 2026

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The document is an Employer Questionnaire Form designed to collect essential information from employers regarding their company details, medical plan information, and employee census data. It includes sections for company identification, medical plan history, employee coverage options, and required documentation for group quotes. The form aims to facilitate the assessment of health coverage options and compliance with insurance requirements.

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Click ‘Get Form’ to open the Employer Questionnaire Rev document in the editor.
Begin by filling out the 'Company Information' section. Enter your employer name, industry, and SIC code if known. Select your business type and form of entity by checking the appropriate boxes.
Provide contact details for both a general contact person and a decision maker, including their titles, telephone numbers, email addresses, and fax numbers.
Indicate whether you have an active business license and if you possess a copy of your Employer Wage and Tax Statement by selecting 'Yes' or 'No'.
Move on to the 'Medical Plan Information' section. Specify the type of plan and current carrier history for the past five years. Fill in employer contributions for employees and dependents as required.
Complete the 'Census Information' section by entering total employee counts across various categories. Ensure that census data is prepared in Excel format as specified.
Finally, gather any necessary documents listed at the end of the form to submit alongside your completed questionnaire.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (192 Votes)

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What is a w532 form used for?

This questionnaire is part of a Bureau of Eligibility Verification (BEV) Review, which will help determine your eligibility to receive Cash Assistance. As part of this review, a BEV investigator will visit you at home, if you have a residence. They will show you identification.