• Office of Management and Budget
• Pensions
• Information
• Forms

EMPLOYERS FORMS - PDF

Healthcare Application: Aetna/Blue Cross Blue Shield Dental Application: Dominion Dental/Delta Dental Application for Death Benefit (Form DB-1) Application for Withdrawal of Benefits (Form WB-1) Blood Bank Application/Waiver Form Contribution Retention Notice (Form CRN-1) Creditable Service Form (Form CSE-1) Dental Insurance Coverage Refusal Deposit Authorization Form (Form DA) Designation of Beneficiary (Form GL-1) Designation or Change of Beneficiary Form (Form BEN-1)

Employee Actuarial Information (Form P-1) Health Insurance Coverage Refusal (Form HR) Joint Survivor Beneficiary Form (Form JSB-1) Pension Application Document Checklist (Form ADC) Pension Creditable Compensation (Agency) (Form PCC-1) Pension Creditable Compensation (School) (Form PCC-1) Pension Income Tax Withholding Election (Form TWE-1) Revised Judicial Plan Joint Survivor Beneficiary Form (Form JSB) Service Cheat Sheet Signature Authorization Form (Form SA) Spousal Coordination of Benefits Form

In order to read the forms in .PDF Format, you must have Adobe's Acrobat Reader installed on your computer.  If you don't already have this utility, you can download a free copy from Adobe's Web Site by clicking on the Acrobat Reader icon, below.

EMPLOYERS FORMS - WORD TEMPLATES Complete with Microsoft WORD Application for Death Benefit (Form DB-1) Application for Pension (Form AP) Application for Withdrawal of Benefits (Form WB-1) Blood Bank Application/Waiver Form Contribution Retention Notice (Form CRN-1) Creditable Service Form (Form CSE-1) Dental Insurance Coverage Refusal Deposit Authorization Form (Form DA) Designation of Beneficiary (Form GL-1) Health Insurance Coverage Refusal (Form HR) Pension Creditable Compensation (Agency) (Form PCC-1) Pension Creditable Compensation (School) (Form PCC-1) Signature Authorization Form (Form SA)

Last Updated: Wednesday, 23-Jul-2008 08:42:42 EDT