Here's how it works
How to use or fill out ps 404 with our platform
- Click ‘Get Form’ to open the PS-404 in the editor.
- Begin by filling out your personal information in boxes 1-9. Ensure you provide your full name, Social Security number, and contact details accurately.
- In box 10, indicate any dependents you wish to add or delete. Check the appropriate boxes for Medical, Dental, and Vision coverage as applicable.
- For new employees, complete section 11 (A-C) to select your coverage options. You can choose between individual or family enrollment and specify your pre-tax status.
- If you need to change or cancel coverage, refer to box 12. Indicate whether you're changing from individual to family coverage or vice versa.
- Complete box 14 if you're going on leave without pay or retiring, ensuring you understand the implications for your health insurance coverage.
- Finally, review all entries for accuracy before signing and dating the form at the bottom.
Start using our platform today for free to simplify your PS-404 form completion!
It's free
See more ps 404 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) |
Got questions?
Can I sign my ps 404 with my mobile phone?
Yes, it is possible with DocHub. This trustworthy and compliant online editor has a phone-based signing option. After you log in to your DocHub account and add your ps 404 to our editor, fill out all empty fields and utilize the Sign feature on the top barf. Click on Create your signature and choose Phone from the available options. Here, you scan a QR code using your smartphone and draw your signature on your phone screen, as you usually do when signing hard copies. If you access DocHub right from your mobile device, you can eSign your template by drawing your eSignature, uploading its picture, or simply with a typed name.
How do you complete ps 404 online?
You may complete and eSign your ps 404 online, even on a tight deadline. All you need to access top-notch editing tools on any device is a DocHub profile, that you can sign up in a couple of moments. After you sign up, add your document or find what you are searching for in our catalog, complete it using the editing tools you want, and put your electronic signature on it at the end.
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
Learn more
