Web Reference: CHANGE OR CORRECTION of Non-Commercial License. Complete Section A, C and F. Notarization is not required. An update card will be issued. Pennsylvania strongly supports organ and tissue donation because of its life-saving and life-enhancing opportunities. This form replaces all enrollment/change forms previously submitted. You must complete the entire form, including the dependent section for any children you want to continue to cover. This change will begin on January 1, 2026. As the CLE, you can tell Tempus to change your DCW’s hourly pay rate by sending in a DCW Rate Change Form. If Tempus gets your form by May 8, 2026, payments will be made going back to January 1, 2026. If Tempus gets your form after May 8, 2026, the new hourly pay rate will start for your DCW the first pay period after Tempus processes your form.
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