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 2023
February 2023
March 2023
April 2023
May 2023
June 2023
July 2023
August 2023
September 2023
October 2023
November 2023
December 2023

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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