Benefits Forms

• Annual Leave Donation Application
• Annual Leave Donation Donor's Certificate of Transfer
• Benefit Change Request Form (This is used for qualifying event changes throughout the year)
• Clinic Current Health Insurance Validation
• Dependent Care Claims Form
• Flex spending account - Dependent Care Claims Form 
• Flex - Health Care Reimbursement Claim Form
• Flex Debit Card Request 2019
• HSA Bank Application (only if you are enrolling into a HSA 1168/1169 Plan)
• HIPPA Authorization Form (Must have if working with Personal History Information)
• Leave programs - Sick Leave Pool Membership Request
• Life Beneficiary Change Forms
• Life Evidence of Insurability
• Long Term Disability Evidence of Insurability
• Opt Out Agreement
• Sick Leave Pool Request
• Tobacco Discount Form

FRS Forms

Some commonly requested FRS forms on the Department of Management Services website are:

• Drop Application
• FRS Retirement Application
• Disability Retirement Application for Pension Plan Members
• FRS Beneficiary Form
• Health Insurance Subsidy Packet for Investment Plan Members
• Health Insurance Subsidy Packet for Pension Plan Members
• FRS Retiree Direct Deposit Form
• Tax Withholding Form for Retirees
• In State and Out of State Credit Form
• FRS Local Senior Management Service Form
• FRS Election Form
• FRS Second Election Form