IC - HR Data Companion Form

1

Name

2

Agency

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Client Name

4

Plan Year Start Date

Date

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Plan Year End Date

Date

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Enrollment Start Date

Date

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Enrollment End Date

Date

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Client Administrators

9

How will you communicate with the carrierPlease click all that apply

Enrollment Form

Spreadsheet

EDI

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Number of Pay Periods

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Please download and fill out the Census Spreadsheet available here:
Census Spreadsheet Download

(You will upload the completed Census in the next section)

Todo

In Progress

Done

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Census Spreadsheet UploadSupported formats: Excel, .CSV

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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