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The document is a Dental Plan Enrollment Authorization form from the California Department of Human Resources. It outlines the process for employees to enroll in, change, or cancel their dental plan coverage, including sections for personal information, dependent details, and authorization for payroll deductions. It also includes a privacy notice regarding the handling of personal information.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (124 Votes)
2019	4.4 Satisfied (251 Votes)
2016	4.3 Satisfied (129 Votes)
2012	4.4 Satisfied (180 Votes)
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