Can the questionnaire be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in adopted states, provided the signature demonstrates intent, consent, attribution, and retention capability; some exceptions may apply.

When is notarization or witness required?

Most jurisdictions do not require notarization for a questionnaire attestation, but state rules vary; if a notarization is requested by a carrier or required for a related filing, follow the state’s notary or witness requirements.

Who should sign the attestation?

An authorized company representative who can verify payroll and enrollment data should sign; document the signer’s title and contact details to avoid later disputes during carrier verification.

How should I calculate FTEs?

Use your employer’s standard FTE method, document the formula and rounding rules, and reconcile to payroll reports. Inconsistent methods can trigger underwriting adjustments.

What supporting documents are required?

Attach payroll snapshots, census exports, and benefits enrollment reports to substantiate counts; carriers will request evidence for underwriting and auditing purposes.

How long must I keep the completed questionnaire?

Retain signed questionnaires for at least three years after filing for tax reasons (IRC §6501(a)) and up to six years for HIPAA‑covered healthcare records (45 CFR §164.530(j)); state rules may require longer retention.

Electronic Signature
Templates
HR
HR Group Size Questionnaire

HR Group Size Questionnaire

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HR GROUP SIZE QUESTIONNAIRE

Company / Group Information

Company Name Group / Division Identifier Business Address

Main Phone

Federal Tax ID (if applicable)

Contact for Questionnaire

Full Name Title / Position

Phone

Email

Personal Information (Person Completing)

Full Legal Name Home Address

Phone

Email

Position Information (Person Completing)

Department Reporting Manager

Start Date with Employer

Current Annual Salary

Group Size Summary

As of Effective Date: , provide the counts below. Counts must reflect active employees on payroll eligible for consideration.

Total Active Employees

Full-Time Employees (FT)

Part-Time Employees (PT)

Seasonal / Temporary

Number of Contractors (on payroll)

Number Eligible for Benefits

Average regular hours used to determine eligibility (per week):

Employee Census by Classification

Provide breakdown by job class or location. Include all active employees in each class.

Class / Location 1 — Title or Location Class / Location 2 — Title or Location Additional Classes / Notes

Coverage and Eligibility Rules

Are firm eligibility rules established for benefits (minimum hours, service requirement, waiting period)? Yes No

If yes, specify hours, service period, waiting period and any eligibility exclusions

Is the group subject to a collective bargaining agreement that affects benefits? Yes No

If yes, provide a concise summary of bargaining units and bargaining agent

Prior Coverage / Changes

Prior Group Carrier Prior Policy Period Reason for Changes (if any)

Employment History (Person Completing) — Employer 1

Employer Name Title / Position Dates Employed Primary Responsibilities Reason for Leaving

Employment History (Person Completing) — Employer 2

Employer Name Title / Position Dates Employed Primary Responsibilities Reason for Leaving

Education

Highest Degree or Certification Institution Graduation Date Additional Training / Certifications

References (Professional)

Provide three professional references who can verify employment and role within the organization or industry.

Reference 1 — Name Reference 2 — Name Reference 3 — Name

Legal Disclosures

At-Will Employment: Nothing in this questionnaire is intended to alter any at-will employment relationship. Submission of this questionnaire does not constitute an employment contract or guarantee of employment duration.

Equal Employment Opportunity: The employer represented by this questionnaire is and will remain an equal opportunity employer. All personnel actions shall be taken without unlawful discrimination on the basis of protected characteristics.

Certification and Authorization

I certify under penalty of perjury that the information provided in this HR Group Size Questionnaire is true, complete, and accurate to the best of my knowledge. I understand that material misstatements or omissions may result in administrative action and may affect group benefit eligibility. I further certify that I am authorized to provide this information on behalf of the employer named above.

Authorization: I authorize the employer, its agents, and any reviewer to verify the information provided, to contact references and prior employers, and to obtain employment-related records and verification necessary for administration of group benefits and compliance. I consent to such verifications and releases as necessary to confirm the accuracy of this submission.

Additional Remarks or Material Facts

Print Name:

Signature:

Date:

What the HR Group Size Questionnaire Is and When It’s Used

The HR Group Size Questionnaire is a standardized form employers and brokers use to report employee counts, full‑time equivalents (FTEs), and related workforce demographics. Insurers, benefits administrators, and HR teams use it to determine group plan eligibility, premium calculations, and compliance with employer‑sponsored coverage rules. Accurate completion supports underwriting, benchmarking, and audit readiness and reduces downstream reconciliation between payroll, benefits, and carrier records.

Why a Consistent Group Size Questionnaire Matters

Using a standardized questionnaire produces consistent headcount and FTE data, supports correct premium pricing, reduces audit exposure, and speeds carrier underwriting and benefits administration.

Who Typically Completes or Reviews This Questionnaire

The questionnaire is usually completed by HR or benefits staff and reviewed by brokers or carriers before plan renewals or rate quotes.

HR manager or benefits administrator responsible for payroll and enrollment data verification.
Broker or benefits consultant preparing quotes and comparing carrier offers.
Insurer underwriter or account manager validating eligibility and pricing.

Final attestation and signature come from an authorized company representative who can verify payroll and benefit eligibility data.

Stepwise Process to Complete the Questionnaire

Follow these sequential steps to gather, calculate, verify, sign, and distribute the completed questionnaire to carriers or brokers.

01

Gather Documents: Collect payroll reports, census, benefits enrollment snapshots.
02

Enter Data: Populate fields, use MM/DD/YYYY and numeric formats.
03

Verify Calculations: Check FTE math and reconcile to payroll totals.
04

Sign & Send: Authorized signer attests and sends to broker/carrier.

How to Configure an Online Questionnaire Workflow

If you deploy the questionnaire digitally, configure automation, conditional fields, signer authentication, and routing to match your approval chain.

Field	Configuration
Automation	Auto‑populate employer name and EIN from HRIS.
Conditional Fields	Show FTE details only when employee count exceeds threshold.
Authentication	Use email code or two‑factor for signer verification.
Routing and Notifications	Route to broker then to carrier with status alerts.

Typical Routing: From HR to Carrier

A standard routing sequence helps ensure the questionnaire reaches all relevant parties in the correct order for review and acceptance.

HR Completion: HR compiles and enters verified payroll and census data.
Broker Review: Broker validates assumptions and requests clarifications.
Carrier Underwriting: Underwriter confirms eligibility and issues rate terms.
Final Attestation: Authorized signer certifies accuracy and submits form.

Digital Format and Integration Requirements

Choose a platform that supports common formats, secure authentication, and integration with HRIS or broker systems.

Supported Formats: PDF, DOCX, and fillable forms are standard.
Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace.
Authentication: Email code, SMS OTP, or stronger MFA options.

Essential Data Elements and Short Notes

Company EIN: Nine‑digit tax identifier

Employee Headcount: Active employees on payroll

FTE Calculation: FTE total and method

Plan Effective Date: MM/DD/YYYY start date

Authorized Signer: Name, title, contact

Supporting Attachments: Payroll snapshot, census

Core Sections Every Professional Questionnaire Should Include

A complete questionnaire groups demographic and eligibility data, explains calculation methods, requests verification attachments, and provides a clear signature and attestation section.

Demographic Summary

High‑level workforce counts by location and job class, used for initial underwriting and tiering; include totals for active and eligible employees.

Eligibility Rules

Describe the employer’s eligibility criteria (hours, waiting periods); carriers rely on this to determine which employees are included in counts.

FTE Method

Document the formula and rounding used to convert part‑time hours to full‑time equivalents to ensure consistent carrier calculations.

Coverage Tiers

List offered tiers (employee only, employee+spouse, family) and associated enrollment counts to support premium allocation.

Verification Attachments

Attach payroll reports, census exports, and benefit enrollment screenshots to substantiate reported totals.

Attestation & Signature

Provide a signer block for an authorized company representative to attest to the accuracy of submitted information under penalty of audit adjustment.

Common Preparation Errors to Avoid

Using inconsistent payroll periods that misalign headcount and FTE totals, leading to carrier rework.
Incorrect FTE formula or rounding rules omitted from the questionnaire instructions.
Submitting unsigned or un‑attested forms that insurers return for completion.
Failing to attach payroll or census reports to substantiate headcount and enrollment figures.

Risks and Penalties from Incorrect Information

Reporting Fines: IRC §6721 reporting fines

ACA Penalties: Employer‑shared responsibility penalties

Premium Recalculation: Retroactive premium adjustments

Audit Exposure: Carrier or regulator audits

Plan Enforcement: Coverage rescission risk

Litigation Risk: Employee or third‑party claims

Timing and Typical Submission Deadlines

Timely submission aligns with carrier underwriting cycles, open enrollment, and renewal windows; internal deadlines help avoid coverage gaps or premium surprises.

Plan Renewal Window:

Submit questionnaire 45–90 days before renewal for underwriting.

Open Enrollment Prep:

Finalize counts 30–60 days before open enrollment launch.

Carrier Underwriting Period:

Allow 10–30 business days for carrier review and follow‑up.

Broker Submission Cutoff:

Adhere to broker deadlines to be included in competitive bids.

Regulatory Filings:

Meet ACA and state reporting schedules if applicable.

Key Milestones from Preparation to Confirmation

Track these numbered milestones to ensure complete and auditable delivery of the questionnaire and any supporting evidence.

01

1. Data Collection

Assemble payroll, census, and benefits export files.

02

2. Internal Review

HR reconciles totals and documents calculation methods.

03

3. External Validation

Broker or carrier reviews and requests clarifications.

04

4. Final Attestation

Authorized signer certifies accuracy and submits.

Real‑World Examples of Electronic Questionnaires in Use

These examples show how organizations reduced turnaround time and improved data accuracy by digitizing group size questionnaires.

Optica Ventures — Brian Fitzgibbons

Optica digitized its forms to streamline client interactions

Improved signer experience and reduced back‑and‑forth
"The interface is simple and easy‑to‑use for our team; more importantly, it is just as easy for our customers."

Xerox — Kodi‑Marie Evans

Xerox integrated questionnaire data into NetSuite for faster reconciliation

Integration reduced manual entry errors
"airSlate SignNow provides us with the flexibility needed to get the right signatures on the right documents, in the right formats, based on our integration with NetSuite."

eSignature Vendor Pricing and Feature Snapshot

Comparative pricing and feature availability for typical eSignature plans; signNow is listed first per vendor column rules.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7‑day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes (Business Premium)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA available)	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions About the HR Group Size Questionnaire

Answers to common questions about legal validity, electronic signing, notarization, retention, and verification when completing the questionnaire.

Need help? Contact support

Can the questionnaire be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in adopted states, provided the signature demonstrates intent, consent, attribution, and retention capability; some exceptions may apply.
When is notarization or witness required?
Most jurisdictions do not require notarization for a questionnaire attestation, but state rules vary; if a notarization is requested by a carrier or required for a related filing, follow the state’s notary or witness requirements.
Who should sign the attestation?
An authorized company representative who can verify payroll and enrollment data should sign; document the signer’s title and contact details to avoid later disputes during carrier verification.
How should I calculate FTEs?
Use your employer’s standard FTE method, document the formula and rounding rules, and reconcile to payroll reports. Inconsistent methods can trigger underwriting adjustments.
What supporting documents are required?
Attach payroll snapshots, census exports, and benefits enrollment reports to substantiate counts; carriers will request evidence for underwriting and auditing purposes.
How long must I keep the completed questionnaire?
Retain signed questionnaires for at least three years after filing for tax reasons (IRC §6501(a)) and up to six years for HIPAA‑covered healthcare records (45 CFR §164.530(j)); state rules may require longer retention.

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