La. Admin. Code tit. 32 § I-717

Current through Register Vol. 50, No. 9, September 20, 2024
Section I-717 - Petition Form
A. Nominating Petition. Nominations will be submitted on a form substantially in compliance with the following.

We the undersigned OGB enrollees are retired teachers or retired school employees/retired state employees and hereby nominate

______________ for membership on the Office of Group Benefits

Policy and Planning Board.

Signature

Printed Name

Last 4 of SSN

Agency

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I hereby certify the persons signing this petition are retired teachers or other school employees/retired state employees and OGB retired enrollees as of the specified nomination date.

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OGB Chief Executive Officer or his/her designated representative

La. Admin. Code tit. 32, § I-717

Promulgated by the Department of Treasury, Board of Trustees, State Employees Group Benefits Program, LR 7:50 (February 1981), amended by the Office of the Governor, Division of Administration, Office of Group Benefits, LR 41:348 (February 2015), effective March 1, 2015, Amended by the Office of the Governor, Division of Administration, Office of Group Benefits, LR 412352 (11/1/2015), effective 1/1/2016.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).