Benefit Forms
Benefits and Services Offered
Flexible Spending Account Forms
- Dependent Care FSA Claim Form
- Flexible Spending - Claim Form (Also referred to as "Healthcare FSA")
- Flexible Spending - Letter of Medical Need
Health Benefit Forms
Life Benefit Forms
Special Forms
- FICA Alternative Plan Distribution Form (Bencor)
- FICA Alternative Plan Direct Rollover Request (Bencor)
- FICA Alternative Plan Enrollment Form (Bencor)
- FMLA Employee Medical Leave
- FMLA Family Leave
- Leave Request Form
- Pre-Tax Waiver
Sick Leave Pool Forms
Retirement Forms
- Cancellation Form for Miscellaneous Deductions and Insurances
- FRS Certification Form
- Retiree Benefits Package
- Tax Deferred Annuity Payroll Authorization
- TDA Local Contacts for 457 and 403(b)
