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Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit) - Jul 2021

Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit) - Jul 2021

The form is used by employees of Mahoning County, Ohio to attest to their eligibility for health insurance coverage under the Ohio Public Employees Retirement System (OPERS).

Originally published by: mahoningcountyoh.gov

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Frequently asked questions

The form is used by employees of Mahoning County, Ohio to attest to their eligibility for health insurance coverage under the Ohio Public Employees Retirement System (OPERS). It should be submitted to the Mahoning County Child Support Enforcement Agency.
Employees of Mahoning County, Ohio who are eligible for health insurance coverage under OPERS.
The completed Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit) should be submitted to the Mahoning County Child Support Enforcement Agency.

Used 59 times

Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit) - Jul 2021

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Frequently asked questions

What is Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit)?

Who needs to fill in Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit)?

Where to submit your completed Uniform Domestic Relations Form Affidavit 4 (Health Insurance Affidavit)?