Form PS-404 Health Insurance Transaction Form for NYS & Pe Employees - New York

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form PS-404 for the current year.

Form PS-404 Health Insurance Transaction Form for NYS & Pe Employees - New York

What Is Form PS-404?

This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the PS-404 form?
A: The PS-404 form is the Health Insurance Transaction Form for NYS & PE Employees in New York.

Q: Who is the PS-404 form for?
A: The PS-404 form is specifically for NYS & PE employees in New York.

Q: What is the purpose of the PS-404 form?
A: The PS-404 form is used for health insurance transactions for NYS & PE employees in New York.

Q: Is the PS-404 form mandatory for NYS & PE employees?
A: Yes, the PS-404 form is mandatory for NYS & PE employees for health insurance transactions in New York.

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Form Details:

  • Released on December 1, 2021;
  • The latest edition provided by the New York State Department of Civil Service;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PS-404 by clicking the link below or browse more documents and templates provided by the New York State Department of Civil Service.

Download Form PS-404 Health Insurance Transaction Form for NYS & Pe Employees - New York

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