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Employee Resources

KSU1-12 Bank Draft Approval for State of Kansas Employee Health Care Program for Non-State Groups

If you've never used the web version of Administrative Forms before, please start by reading the general instructions before proceeding.

As stated in the general instructions, this form can be filled in and printed. Use tab key or mouse to navigate this form.

Please note when typing the dollar amounts the commas will be added automatically. The program will not let you type in commas.

Each month this form is to be signed by the county/district director and the board/governing body chair, treasurer and secretary to approve the bank draft for the premiums for the State of Kansas Employee Health Care Program for Non-State Groups. File a copy with the monthly financial records and mail a copy with the monthly audit information to the K-State Research and Extension Business Office.

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Please send your questions, comments, and suggestions about this form to Cheryl Christian, cchristi@ksu.edu. Thank you.