CS-1788 Plan C Leave Form - State of Michigan
Lansing, Michigan 48909. 800-505-5011. PLAN C - LEAVE OF ABSENCE FORM Instructions: Human Resource Offices should use this form to notify the Employee Benefits Division when an employee is going on a Plan C leave of absence so that the employee/state share of the health, dental, vision, and life insurance premiums may be prepaid. ................
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