The State of California, through its Department of Human Resources, offers government employees a range of benefits, including the Premier Vision Plan (PVP). The enrollment authorization for this program is used to activate vision insurance coverage and to manage any changes to that coverage over time. Completing this document in ink or typewritten format ensures each section is legible and ready for processing by your agency's personnel office.
The document is divided into several sections, each with a specific purpose. The first section captures employee identification details, including your name, Social Security Number, and employing agency. The dependent section applies when you are adding or removing family members from the vision plan. The election section is where you indicate your choice: enrolling in, changing, or canceling Premier Vision Plan coverage. A privacy notice explains how the State Controller's Office and the plan vendor process your personal data in accordance with California privacy regulations.
Authorization for payroll deductions is a key requirement of this enrollment document. By signing, you direct your agency to withhold your share of the vision plan premium from each paycheck. Your Social Security Number serves a dual role: it identifies you to the State Controller's Office and links your record to the vision plan vendor. The enrollment authorization, revised in February 2013, reflects California's commitment to providing its employees with structured access to comprehensive vision care.
| Question | Answer |
|---|---|
| Form Name | Calhr 774 Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | cal hr 774 form, calhr form 744, forms calhr 774, alhr 774 |