Form 1054 Health Benefits Report / Inquiry - New York City

Form 1054 Health Benefits Report / Inquiry - New York City

What Is Form 1054?

This is a legal form that was released by the New York City Office of Labor Relations - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1054 Health Benefits Report/Inquiry?A: Form 1054 is a document used to report or inquire about health benefits in New York City.

Q: Who can use Form 1054?A: Anyone who is eligible for health benefits in New York City can use this form.

Q: What information is required on Form 1054?A: The form requires information such as personal details, health benefit plan information, and any changes or inquiries.

Q: How do I submit Form 1054?A: You can submit Form 1054 by mail, fax, or in-person at the designated city agency.

Q: What is the purpose of filing Form 1054?A: Filing Form 1054 helps individuals report changes, inquire about health benefits, or resolve any issues related to their health benefit plans.

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Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the New York City Office of Labor Relations;
  • 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 1054 by clicking the link below or browse more documents and templates provided by the New York City Office of Labor Relations.

Download Form 1054 Health Benefits Report / Inquiry - New York City

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  • Form 1054 Health Benefits Report / Inquiry - New York City, Page 1
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