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Ca-16 2023 Form: What You Should Know
This form does not have an expiration date. Form CA-16 — Medical and Dental Examinations. This form is valid for persons who are undergoing outpatient (not inpatient) medical examinations in California. This form does not have an expiration date. Form D-4411. This form is generally required for employees in the State of California who may have taken an exam(s) under the Family Caregivers Medical Examinations Act, Caregiving (IC-503) of 2000, or Health Insurance Portability and Accountability Act (HIPAA) of 1996. Employees Certificate of Insurance. This form is for California employees who were insured (on a plan) on the date the employer received the employee's first reportable pay period, and it complies with all the applicable requirements in IC-503 or HIPAA. This form is required if you applied for coverage after April 15, 2016,, and you did not receive a reportable pay period prior to the application date. Federal or State Unemployment Compensation Report of Income. This form is for all employees. This form gives the employees name, address, SSN, and reason for unemployment. Supplemental Security Income (SSI) Report. This form is for any state resident for whom information regarding SSI benefits received is required on a Social Security Record. This form gives the resident's name, address, SSN, and reason for receiving SSI benefits. State Unemployment Insurance (UI) Report of Earned Income. This form is required if UI is claimed or continued in California on the taxpayers own behalf in a timely manner. The Form 6500-A, the States form for filing unemployment insurance return, may be used. Social Security Administration (SSA) Social Security Number Certificate of Eligibility, Form SS-5, from the U.S. Department of Health and Human Services. This form is for the individual with disabilities. State Medicaid Report of Earned Income. If you received Medicaid benefits in California on the date in the federal year in which you applied, this form is required by the state. The Form I-551 Social Security Card can be used for this purpose. California Employment Tax Forms. These tax forms provide information about state employment tax. This information is available in both the PDF and hard copy formats.
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