INSTRUCTIONS: CONNECTICUT REQUEST FOR MARKER PLATES (Form K-6)

To request the marker plates required for registered motor vehicles in Connecticut as a dealer, use form K-6. This document can be obtained from the website of the government of Connecticut.

Connecticut Request For Marker Plates K-6 Step 1: Enter your business name in the first blank box.

Connecticut Request For Marker Plates K-6 Step 2: Enter your license number in the second blank box.

Connecticut Request For Marker Plates K-6 Step 3: Enter your business address in the third blank box.

Connecticut Request For Marker Plates K-6 Step 4: Enter the number of full time employees in the fourth blank box.

Connecticut Request For Marker Plates K-6 Step 5: Enter the number of wreckers in the fifth blank box.

Connecticut Request For Marker Plates K-6 Step 6: Enter the number of delivery trucks in the sixth blank box.

Connecticut Request For Marker Plates K-6 Step 7: Enter the number of repair customers requiring loaner vehicles in the seventh blank box.

Connecticut Request For Marker Plates K-6 Step 8: Indicate with a check mark whether you are requesting initial sets of plates or additional sets of plates.

Connecticut Request For Marker Plates K-6 Step 9: Enter the number of plates you are requesting.

Connecticut Request For Marker Plates K-6 Step 10: The table provided below requires you to document the vehicles in question. Enter the vehicle year in the first column, the make in the second column, the owner or employee's name in the third column, their address in the fourth column, their occupation in the fifth column, whether they are a full or part-time employee in the sixth column, whether they are on your payroll in the seventh column, whether the title is in possession of and assigned to the dealership in the eighth column, and the reason for the loan in the ninth column.

Connecticut Request For Marker Plates K-6 Step 11: If you are a new or used car dealer, enter the number of vehicles sold in the past year or the number of vehicles to be sold in the coming year in the next blank box and the number of vehicles purchased from other dealers, auctions or buyers on any given day in the next blank box.

Connecticut Request For Marker Plates K-6 Step 12: Sign and date the form, as well as providing your title.

INSTRUCTIONS: ALABAMA HEALTH INSURANCE ENROLLMENT FORM (Form IB02)

Alabama state employees can enroll in state-administered health insurance using form IB02. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Health Insurance Enrollment Form IB02 Step 1: Check the first box if applying for SEHIP basic medical coverage administered through Blue Cross.

Alabama Health Insurance Enrollment Form IB02 Step 2: Check the second box if applying supplemental coverage for secondary medical care administered through Blue Cross.

Alabama Health Insurance Enrollment Form IB02 Step 3: Check the third box if applying for optional policies covering vision, dental, cancer or hospital indemnity administered through Southland National.

Alabama Health Insurance Enrollment Form IB02 Step 4: Check the fourth box if you are declining coverage.

Alabama Health Insurance Enrollment Form IB02 Step 5: Enter your name in the first blank box.

Alabama Health Insurance Enrollment Form IB02 Step 6: Enter your sex in the second blank box.

Alabama Health Insurance Enrollment Form IB02 Step 7: Enter your Social Security number in the third blank box.

Alabama Health Insurance Enrollment Form IB02 Step 8: Enter your date of birth in the fourth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 9: Enter your street address in the fifth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 10: Enter your city in the sixth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 11: Enter your state in the seventh blank box.

Alabama Health Insurance Enrollment Form IB02 Step 12: Enter your zip code in the eighth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 13: Enter your home telephone number in the ninth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 14: Enter your work phone number in the tenth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 15: Enter your email address in the eleventh blank box.

Alabama Health Insurance Enrollment Form IB02 Step 16: Document your dependents as instructed in the table provided.

Alabama Health Insurance Enrollment Form IB02 Step 17: If applying for supplemental coverage or Southland, complete the next section concerning additional group health insurance coverage information.

Alabama Health Insurance Enrollment Form IB02 Step 18: Have your employer complete the bottom left hand corner.

Alabama Health Insurance Enrollment Form IB02 Step 19: Sign and date the form where indicated.

INSTRUCTIONS: ALABAMA NOTICE OF CANCELLATION (WC Form 9)

Businesses operating in Alabama use WC Form 8 to notify the state Department of Labor that they have purchased worker's compensation insurance as required by law. WC Form 9, which is discussed in this article, is used to notify the department of the cancellation of this policy. This document can be obtained from the website maintained by the Alabama Department of Labor.

Alabama Notice Of Cancellation WC 9 Step 1: On the first blank line, enter the business state unemployment compensation tax number.

Alabama Notice Of Cancellation WC 9 Step 2: On the second blank line, enter the federal ID number.

Alabama Notice Of Cancellation WC 9 Step 3: On the third blank line, enter the name of your corporation or limited liability company (LLC).

Alabama Notice Of Cancellation WC 9 Step 4: On the fourth blank line, enter the "doing business as" (dba) name of your company.

Alabama Notice Of Cancellation WC 9 Step 5: On the fifth blank line, enter the address of your primary business location.

Alabama Notice Of Cancellation WC 9 Step 6: On the sixth blank line, enter other locations covered in this notice.

Alabama Notice Of Cancellation WC 9 Step 7: On the seventh blank line, enter the nature of your business.

Alabama Notice Of Cancellation WC 9 Step 8: On the eighth blank line, enter your NAICS code number.

Alabama Notice Of Cancellation WC 9 Step 9: On the ninth blank line, enter the date of the cancellation of your workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 10: On the tenth blank line, state the reason for your cancellation of the workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 11: On the eleventh blank line, enter the policy number of the workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 12: On the twelfth blank line, enter the name of the carrier of the cancelled workers' compensation insurance policy.

Alabama Notice Of Cancellation WC 9 Step 13: On the thirteenth blank line, enter the NCCI code of the insurance carrier of the cancelled workers' compensation insurance policy.

Alabama Notice Of Cancellation WC 9 Step 14: File the form by mailing it to the address given at the top of the page.

INSTRUCTIONS: ARIZONA ANNUAL FINANCIAL REPORT FOR BINGO LICENSE CLASS "A" (Form 71-1013)

Arizona bingo games conducted by an establishment with a class "A" license document their proceeds using a form 71-1013. This document can be obtained from the website of the Arizona Department of Revenue.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 1: Enter the beginning and ending dates of your financial reporting period.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 2: Indicate with a check mark if this is an amended report.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 3: In the first blank box, enter the licensee's name and address.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 4: In the second blank box, enter the license number.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 5: In the third blank box, enter the licensee's phone number, including the area code.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 6: On line 1, enter your gross receipts.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 7: On line 2, enter the prizes paid out.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 8: Subtract line 2 from line 1. Enter the resulting difference on line 3. This figure represents your adjusted gross receipts.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 9: On line 4, enter the bingo expenses paid. You should provide a brief description of any bingo expenses paid such as bingo paper, daubers or other supplies. Attach a separate page listing the purpose and amount of each expense.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 10: On line 5, enter the expenditures of net proceeds.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 11: Multiply the amount on line 3 by 2.5%. Enter the resulting product on line 6. a

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 12: Enter the penalty and interest due, if any, on line 7.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 13: Add lines 6 and 7. Enter the resulting sum on line 8. Sign and date the form and enter your title at the bottom of the page.

INSTRUCTIONS: CONNECTICUT PREFERRED PROVIDER NETWORK (PPN) LICENSE INSTRUCTIONS AND APPLICATION (RENEWAL)

To apply for a renewal of a license to act as a Connecticut preferred provider network (PPN), use the application discussed in this article. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 1: The first page contains general instructions.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 2: Enter the name of the PPN on the first blank line of the second page.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 3: Enter the PPN license number on the second blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 4: Enter the PPN tax identification number or federal employer identification number on the third blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 5: Enter the PPN business address on the fourth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 6: Enter the PPN mailing address, if different, on the fifth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 7: Enter the PPN phone number on the sixth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 8: Answer the three questions on this page by filling in the oval next to "yes" or "no" as applicable. Note that if you answer either of the first two questions "yes," you are not required to complete this application. 

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 9: On the third page, answer the first question about whether any suspensions, sanctions or disciplinary actions have been taken against the controlling company or organization in the last 10 years in any state by filling in "yes" or "no" as applicable. If yes, provide an explanation.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 10: Enter a description of the PPN's service area.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 11: Enter the number of total enrollees served by the PPN both nationwide and in Connecticut.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 12: Complete the rest of the application as instructed.

INSTRUCTIONS: CONNECTICUT 2012 CONSUMER REPORT CARD – PART 1

Connecticut managed care organizations are required to file an annual consumer report card in two parts. This article discusses part 1 of this form, which can be obtained from the website maintained by the government of Connecticut.

Connecticut 2012 Consumer Report Card – Part 1 Step 1: On the first page, enter the name and address of the managed care organization, the name and title of a contact person, and a contact phone number and email address.

Connecticut 2012 Consumer Report Card – Part 1 Step 2: Enter the total Connecticut direct written health premiums from managed care plans.

Connecticut 2012 Consumer Report Card – Part 1 Step 3: Indicate whether you are profit or not for profit with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 4: Indicate whether you are an HMO or indemnity organization with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 5: Indicate with a check mark whether you have applied for NCQA accreditation. If yes, indicate what kind of accreditation you received with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 6: Indicate with a check mark whether you market managed care to individuals. If yes, indicate whether you offer care directly or through an association.

Connecticut 2012 Consumer Report Card – Part 1 Step 7: On the second page, indicate whether you contract directly with providers or with individual networks and answer all other questions about your services.

Connecticut 2012 Consumer Report Card – Part 1 Step 8: The third page concerns your federal medical loss ratio, customer service information, utilization review data, percentage of employers or groups that did not renew their contracts in the previous year, and enrollment.

Connecticut 2012 Consumer Report Card – Part 1 Step 9: The fourth page requires you to document the total number of participating primary care physicians and participating physician specialists located in each county of Connecticut as of the end of the previous calendar year.

Connecticut 2012 Consumer Report Card – Part 1 Step 10: The fifth page requires you to document the total number of participating acute care hospitals and pharmacies located in each county of Connecticut as of the end of the previous calendar year. An officer should sign and date the bottom of the page.