R698-8-4. Participation Process

  (1) An employer that elects to participate in the trust fund shall submit no later than June 30, 2017:

  (a) a cost sharing agreement form approved by the board;

  (b) a certificate of eligible employees form approved by the board that identifies the number of eligible members as of March 31, 2017; and

  (c) the required annual premium payment as determined by the board.

  (2) The information described in Subsection R698-8-4(1) shall be addressed to the Commissioner's office of the Department of Public Safety, Attn. Trust Fund.

  (3) The cost sharing agreement form shall contain the following:

  (a) the name, address and phone number of the employer; and

  (c) the name, mailing address and signature of the agency administrator completing the cost sharing agreement form.