"Notification of Change of Address" - Rhode Island

Notification of Change of Address is a legal document that was released by the Rhode Island Department of Administration - a government authority operating within Rhode Island.

Form Details:

  • Released on March 6, 2019;
  • The latest edition currently provided by the Rhode Island Department of Administration;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Administration.

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Download "Notification of Change of Address" - Rhode Island

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Revised 3-6-19
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Administration
Division of Human Resources
Notification of Change of Address
Name of Employee:
Home Phone #:
Department & Division/Section:
Old Address:
Number
Street
City
State
Zip
New Mailing
Address:
Number
Street
City
State
Zip
***If new mailing address is a post office box, please indicate residence address below:
Residence
Address:
Number
Street
City
State
Zip
__________________________________
__________
Signature of Employee
Date
Note that a few of the State’s health and benefit vendors require that you update your address directly – this
Change of Address form will not update your address with these vendors and you must update your address on
your own:
Navia Benefit Solutions (FSA): https://www.naviabenefits.com/; or 800-669-3539
Aetna Life Insurance: www.aetna.com; or 800-523-5065
Aflac (Short Term Disability): 401-475-9936, ext. 130
Colonial Life (Short Term Disability): http://www.visityouville.com/en/StateOfRI; or 866-349-8011
College Bound Saver (529 Plan): https://www.collegeboundsaver.com/; or 877-517-4829
This Change of Address Form must be submitted to your local human resources representative for processing. For an
up-to-date listing of human resources representatives for each assigned Executive Branch agency, please click here.
For all other non-Executive Branch organizations, please submit this form to your local administrative representative.
Revised 3-6-19
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Department of Administration
Division of Human Resources
Notification of Change of Address
Name of Employee:
Home Phone #:
Department & Division/Section:
Old Address:
Number
Street
City
State
Zip
New Mailing
Address:
Number
Street
City
State
Zip
***If new mailing address is a post office box, please indicate residence address below:
Residence
Address:
Number
Street
City
State
Zip
__________________________________
__________
Signature of Employee
Date
Note that a few of the State’s health and benefit vendors require that you update your address directly – this
Change of Address form will not update your address with these vendors and you must update your address on
your own:
Navia Benefit Solutions (FSA): https://www.naviabenefits.com/; or 800-669-3539
Aetna Life Insurance: www.aetna.com; or 800-523-5065
Aflac (Short Term Disability): 401-475-9936, ext. 130
Colonial Life (Short Term Disability): http://www.visityouville.com/en/StateOfRI; or 866-349-8011
College Bound Saver (529 Plan): https://www.collegeboundsaver.com/; or 877-517-4829
This Change of Address Form must be submitted to your local human resources representative for processing. For an
up-to-date listing of human resources representatives for each assigned Executive Branch agency, please click here.
For all other non-Executive Branch organizations, please submit this form to your local administrative representative.