Forms

Please choose a form below to download.

Statement of Claim Form / Medical Claim Form

To submit the Statement of Claim / Medical Claim Form you can download the form from this link and submit the completed claim form to the address provided at the top of the form. You must complete and sign a Statement of Claim form at least once each year.

Dental Claim Form

To submit a dental claim for processing you can download a Dental Claim Form from this link and submit completed claim form to the address provided at the top of the form.

Short Term Disability Form

Please fill this form out to file a Short Term Disability report.

Pension Direct Deposit Form

Please fill this form out to authorize Pension check direct deposit.

Pension Application Form

Please fill this form out to request a Pension distribution.

HRA Reimbursement Form

Please use this form to submit a Healthcare Reimbursement Account reimbursement request.

COVID-19 Tax Deferral Withdrawal Application

Please use this form to request an Emergency withdrawal from the Tax Deferral Plan. Both the application and IRS-W4 form must be completed and provided to the Administrative Office. The form requires a notary which cannot be waived.