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Employer Website Focus Group Sign-Up
Employer Website: Focus Group Sign-up
Please complete the form below and click submit.
Company Name:
Contact Name:
Phone:
Email Address:
1. How many employees does your company have?
1-10
11-50
51-100
101-500
501+
2. Do you have previous experience with National Medical Support Notices and/or Income Withholding Orders?
Yes
No
3. Insurance coverage offered by your company (check all that apply):
Health
Dental
Vision
None
3a. Do you use a third-party Health Plan Administrator?
Yes
No
3b. If Yes, provide the company name:
4. Please provide any suggestions, feedback, and/or items or features you would like to see included on the employer website:
5. In addition to this initial focus group, would you be interested in participating in a follow-up focus group to test the functionality of the Employer website?
Yes
No
Maybe
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