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 2021
February 2021
March 2021
April 2021
May 2021
June 2021
July 2021
August 2021
September 2021
October 2021
November 2021
December 2021

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 Member Services Administration at 888-672-0062.

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