Online Group Size Questionnaire

Online Group Size Questionnaire


Please fill in the following employer information:

  Column A.
Total number of full-time employees
(as of the end of the month)
Column B.
Total number of part-time employees
(as of the end of the month)
Column C.
Others not reported in Column A or B
Combined total
(add total from Columns A+B+C)
January 2024
February 2024
March 2024
April 2024
May 2024
June 2024
July 2024
August 2024
September 2024
October 2024
November 2024
December 2024

Employers

Group Information

Employer Verification

By entering your name here, you are giving your legal signature.

Thank you for your cooperation in this important federal compliance matter.
Questions? Please contact Customer Service at 888-672-0062.

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