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Benefits Office - GENERAL FORMS

Click Here for Direct Deposit Form
[1/1/2007] - Click on the headline to download form. link

Medical Forms

Dental Claim Form [8/10/2007] - Click on headline to download form. link

Health Insurance Claim Form [8/10/2007] - Click on headline to download form. link

Notice of Privacy Practices (HIPAA) [1/1/2007] - Click on the headline to download form. link

Tax Related Forms

Withholding Certificate for Pension or Annuity Payments (form W-4P) for tax year 2008 [1/1/2008] - Click on the headline to download form. link

Annuitant's Request for Income Tax Withholding [1/1/2007] - Click on headline to download form. link

Personal Welfare Account Forms

Personal Account Reimbursement Form [7/25/2007] - Click on headline to download form. This form may be used for claims involving Health Care, Dental, Hearing and Vision reimbursements. link

Loss of Time Benefits [1/1/2007] - Click on the headline to download form. link

Claimant's Supplementary Report for Loss of Time Benefits [1/1/2007] - Click on headline to download form. This report should be filled out and returned to the Fund as soon as possible. link

Personal Welfare Account Reimbursement Policy [1/1/2007] - Click on headline to download form. link

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