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Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Form

State:
Pennsylvania
Control #:
PA-SKU-4626
Format:
PDF
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Description

Group Self-Insurance Fund Member Annual Contribution Worksheet Form The Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Form is used by members of the Pennsylvania Group Self-Insurance Fund (PGS IF) to calculate the amount of their annual contribution for the upcoming policy year. This form is completed by the employer, and it includes information about the employer’s total liability for the upcoming policy year and the annual contribution amount. The form also allows the employer to make any necessary adjustments to their annual contribution amount. There are two types of Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Forms: the Initial Contribution Worksheet Form and the Contribution Adjustment Worksheet Form. The Initial Contribution Worksheet Form is used to calculate the employer’s initial annual contribution amount. The Contribution Adjustment Worksheet Form is used to make any necessary adjustments to the employer’s annual contribution amount.

The Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Form is used by members of the Pennsylvania Group Self-Insurance Fund (PGS IF) to calculate the amount of their annual contribution for the upcoming policy year. This form is completed by the employer, and it includes information about the employer’s total liability for the upcoming policy year and the annual contribution amount. The form also allows the employer to make any necessary adjustments to their annual contribution amount. There are two types of Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Forms: the Initial Contribution Worksheet Form and the Contribution Adjustment Worksheet Form. The Initial Contribution Worksheet Form is used to calculate the employer’s initial annual contribution amount. The Contribution Adjustment Worksheet Form is used to make any necessary adjustments to the employer’s annual contribution amount.

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Pennsylvania Group Self-Insurance Fund Member Annual Contribution Worksheet Form