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Form Uc 1208 Medical-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling in the 'Employer Name' as it appears on the Pennsylvania Enterprise Registration Form (Form PA-100).
- Enter the 'PA UC Account Number', which is a seven-digit number found on various official documents from the department.
- Provide your 'FEIN' (Federal Employer Identification Number) in the format of two digits, a dash, and seven digits.
- In Part A, confirm the benefits address where all correspondence will be sent. Ensure accuracy for effective communication.
- In Part B, appoint an attorney-in-fact if necessary. Fill in their name and address, and check the appropriate boxes for correspondence categories they will receive.
- Ensure both you and your attorney-in-fact sign and date the form as required. This step is crucial for validation.
- Finally, submit your completed form via email, fax, or mail as instructed at the end of the document.
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Related links
Complete the Alternative Budget Request form and submit to financialaid@health.ucdavis.edu. Suite 1208 | Sacramento, Financial Aid Office: 916-734-4120
This form is used by employers to voluntarily elect coverage under the UC Law, even though services are performed entirely in another state.Read more
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