La. Admin. Code tit. 32 § I-717

Current through Register Vol. 50, No. 11, November 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	Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
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. _________________________________________________________ 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).