Information Change

	Choose a form below
	Income Tax Withholding Election Form Change of Beneficiary Form Change of Address Form Direct Deposit Form Agreement for Domestic Relations Order Authorization/Request for a DRO Estimate Parties of the DRO Reimbursement Affidavit (page 1 of 2) Reimbursement Application (page 2 of 2) Retirement Checklist DRO Court Order Separation Form Request for Retirement Estimate

Select an information form. To print the form, click on the form itself, and then select "File" and "Print" from your browser menu.

Once you have filled out the printed form, please sign it and return it to the fax number or address that you see at the top of this page.

Health/Dental/Vision Insurance Enrollment Form
The enrollment form for Health/Dental/Vision insurance is a fillable form. Please fill out your form online, then print and sign it before mailing it to the Plan.

Forms for the Out of State Premium Reimbursement - The Affidavit accompanies either form. Please print and fill out BOTH the appropriate form and the Affidavit linked below:

REIMBURSEMENT APPLICATION - Members Under Age 65

REIMBURSEMENT APPLICATION - Members Over Age 65

REIMBURSEMENT AFFIDAVIT