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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.
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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