Please choose a form below to download.

Notice to Return to Work & Request for Resumption of Benefits

These forms are for retirees who wish to return to work.

Vision Expenses Claim Form

Please fill this form out to claim vision expenses

Prescription Mail Order Form

Please fill this form out for mail order prescriptions.

Prescription Reimbursement Claim Form

Please fill this form out to file a prescription reimbursement claim.

Address Change Form for Fringe Benefits

Please fill this form out to file a change of address for fringe benefits.

Transfer Authorization form for Fringe Benefits

Please fill out this form to authorize transfer of fringe benefits.

Loss of Time Claim Form

Please fill out this form to file a loss of time claim.

Health Beneficiary Designation Form

Please fill this form out to file a change of health benefits beneficiary designation.

Vacation Beneficiary Designation Form

Please fill this form out to file a change of vacation benefits beneficiary designation.

Request for Information Sheet

This is the form to request information to enroll.

Please choose a form below to download.

Change of Address Form

Please complete this form to report a change in mailing address, and send it to the address provided in the form.

Direct Deposit Form

Please complete this form to request Direct Deposit, and send it to the address provided in the form.

Notice to Return to Work & Request for Resumption of Benefits

These forms are for retirees who wish to return to work.

Tax Withholding Certificate for Pension or Annuity Payments

This is form W-4P from the Internal Revenue Service.

Money Follows Man Reciprocity Form

This form is to Request Transfer of Contributions to Home Local Pension Fund.

Beneficiary Designation Form

Please fill this form out to file a change of beneficiary designation.