Forms

Affidavits/Declarations

Affidavit of Marriage (County)

Affidavit of Marriage (CalPERS)

Affidavit of Eligibility for Economically Dependent Childern (CalPERS)

Declaration of Tax Dependent Status

Deferred Compensation

Nationwide Beneficiary Change Form

Nationwide Distribution Request Form

Deferred Compensation Change Form

AIG Distribution Request Form

AIG Beneficiary Designation Form

AIG Transfer In/Rollover Form

AIG Intra Plan Transfer Out

Disability Insurance

Standard Long Term Disability Claim Form

Standard Life Long Term Disability (LTD) Certificate

Sedgewick/VPA Disability Forms

Flexible Spending Accounts

Dependent Care FSA Claim Form

Health Care FSA Claim Form

Health Care Letter of Medical Necessity

Health Care Capital Expense Worksheet

General Forms

Employee Status Change Form

Password Security

Beneficiary Designation to Receive Warrant

Health (Medical) Benefits

2010 Active Employee Annual Enrollment Guide (Full Version)

2010 Active Employee Annual Enrollment Mini-Guide

CalPERS 2010 Annual Enrollment Website (CalPERS Plans)

Active Employee Benefit Election Form 2010 (County Plans)

Active Employee Benefit Election Form 2010 (CalPERS Plans)

Health Plan Enrollment Form HBD-12 (CalPERS)

Retiree Medical/Health Benefits Forms

Statement of Financial Liability for Domestic Partner Health Benefits (County Pl

Member Questionniare for Disabled Dependent Benefits (CalPERS)

Statement of Financial Liability for Domestic Partner Health Benefits (CalPERS)

Medical report for Disabled Dependent Benefits (County Plans)

Medical Report for Disabled Dependent Benefits (CalPERS)

Member Questionnaire for Disabled Dependent Benefits (County Plans)

Zip Code Election (HBD109) (CalPERS)

After-Tax Benefit Plan Election Form 2009

Retirement

Early Retirement Incentive Information (Benefits Website)

MGMT Notification of Retirement - Intent to Use Leave Accruals in Lieu of Mandatory Furlough

Retiree Address Change Form

SEIU Notification of Retirement - Intent to Use Leave Accruals in Lieu of Mandatory Furlough

VEBA Claim Form

VEBA Systematic Payment Form

Retirement Plan Options

401(a) Election Form

CalPERS Beneficiary Designation Form

Post Employment Program Election Form (Mgmt, Conf, Unrep, DDAA & LEMU only)

Post Employment Program Election Form (LIUNA & SEIU Only)

2010 Retiree Annual Enrollment Guide

2010 Retiree Benefit Election Form

Retirement Publications and Additional Forms (Benefits Website)

Retirement Plans Information (Benefits Website)

Leave Forms

Click here for Leave Forms.

Life Insurance

Lincoln Financial Life Insurance

Lincoln Financial Basic Life Insurance Certificate
(All SEIU & LIUNA employees have this coverage, paid for by the County.)
Lincoln Financial Beneficiary Designation Form
Lincoln Financial Enrollment Form for Group Insurance
Lincoln Financial Evidence of Insurability
Lincoln Financial Life Insurance Claim Form
Lincoln Financial BeneficiaryConnect Services
Lincoln Financial Supplemental Life Insurance Certificate
Lincoln Financial Portability/Conversion Summary
Lincoln Financial Conversion Form
Lincoln Financial Portability Form
Lincoln Financial TravelConnect Services

Standard Life Insurance

Transportation Expense Program

Rideshare Registration

Enrollment/Change Form

Reimbursement Claim Form

Vision

Medical Eye Services Claim Form

Health & Wellness Links

Healthy Lifestyle Rewards

Wellness Programs

Leave Balance Cash-Outs

One-Time Pre-Retirement Leave Cash-Out (LIUNA & SEIU only)

One-Time Pre-Retirement Leave Cash-Out (Management)