DSHS Form 09-728 Washington State Addendum to Box 2 of Part B - Plan Administrator Response - Washington

DSHS Form 09-728 Washington State Addendum to Box 2 of Part B - Plan Administrator Response - Washington

What Is DSHS Form 09-728?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 09-728?A: DSHS Form 09-728 is an Addendum to Box 2 of Part B - Plan Administrator Response specific to Washington State.

Q: What is the purpose of the addendum?A: The addendum is used to provide additional information or updates to the Plan Administrator Response form.

Q: Who is required to fill out this addendum?A: The Plan Administrator or their designated representative is responsible for completing this addendum.

Q: How should I complete the addendum?A: Follow the instructions provided on the addendum form to accurately complete the required sections.

Q: When should I submit the addendum?A: Submit the completed addendum along with the Plan Administrator Response form within the specified timeline indicated by DSHS.

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Form Details:

  • Released on January 1, 2008;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Available in Russian;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DSHS Form 09-728 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 09-728 Washington State Addendum to Box 2 of Part B - Plan Administrator Response - Washington

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