Forms

Domestic Partnership Forms

• Declaration of Domestic Partnership
• Termination of Domestic Partnership
• Declaration of Dependent Tax Status – Domestic Partner Benefits
• Termination of Dependent Tax Status – Domestic Partner Benefits

Health Plan Forms

• Online Health Enrollment
• Quick Claim Form
• CVS Caremark Mail Order Prescription Form

Flexible Spending and Transportation Reimbursement Accounts

• FSA Online Enrollment
• FSA Claim Form
• TRA Claim Form
• FSA Direct Deposit Enrollment Form

Family and Medical Leave Forms

• Family Medical Information Form
• FMLA Intermittent Parental Leave Form - EPD
• FMLA Intermittent Parental Leave Form - FIRE

Leave Donation Program Form

• Leave Donation – Donor Form

Life Insurance Forms 

• COE Life Insurance Enrollment/Beneficiary Change Form - Standard Insurance
• Supplemental Life Application - Employee- The Hartford
• Supplemental Life Application - Spouse/DP - The Hartford

Retirement Benefits Forms

• PERS Beneficiary Form (Tier1/2)
• PERS/OPSRP IAP Beneficiary Form – Individual Account Program (IAP)
• Deferred Comp Catch-up & Rollover Election Form

Retirement and Employment Separation Forms

• Retiring Employee Information
• Employment Separation Information
• Retiree/COBRA Health Plan Open Enrollment Form
• Deferred Comp Catch-up & Rollover Election Form