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A plan or insurer may provide a SBC in paper form or electronically, if the requirements of the Department of Labor's electronic disclosure safe harbor are met. If SBCs are to be mailed and the employee and any eligible dependents are known to reside at the same address, a single SBC may be provided to that address. If renewal is automatic, the SBC must be provided no later than 30 days prior to the first day of coverage in the new plan year. 2  Group health plans that offer more than one benefit option can provide just the SBC for the benefit option the participant is already enrolled in with the open enrollment materials.
certify that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and 210. PRINT OR TYPE REPRESENTATIVEâS NAME SIGNATURE OF REPRESENTATIVE TELEPHONE NUMBER DATE. Financial institutions should refer to the GREEN BOOK for further instructions. THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE. NSN 7540-01-058-0224. FINANCIAL INSTITUTION COPY