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HSU Forms

Benefit Enrollment Worksheet

Department: 
Human Resources
Format: 
PDF
Routing Instructions: 
Complete this form indicating the appropriate enrollment information and submit to Human Resources for processing. All changes outside of Open Enrollment must have a permitting event and will take effect on the first of the month following the event or when the form is submitted, whichever is later. Some permitting events expire after 60 days, so timely submission is important!
Last Updated:  Tue, 08/26/2014 - 14:49
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