2810-2026

1. Click ‘Get Form’ to open the 2810 in the editor.
2. Begin with Part A, where you will enter your identifying information. Fill in your name, date of birth, social security number, home address, payroll office number, and enrollment code number.
3. In Part B, if applicable, indicate the termination date of your enrollment. If this is due to death, provide the date of death.
4. Proceed to Parts C through F for any transfers, reinstatements, or changes in enrollment status. Ensure all relevant details are accurately filled out.
5. Use Part G for any additional remarks that may be necessary for your situation.
6. Finally, complete Part H by providing the date of notice and agency contact information before saving your document.

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