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Benefit Forms

Employment Forms:

• Beneficiary Designation
  Used to designate or change the beneficiary for Basic Life, Optional Life, and Accidental Death & Dismemberment Insurance policies.  You may fill out this form online prior to printing.

• Benefit Change Form
  Used to change health, dental, optional life, dependent life, accidental death & dismemberment, long-term disability, or long-term care coverage in the event of a qualified family status change outside of the annual enrollment period (July of each year).  You may fill out this form online prior to printing.

• Dependent Benefit Enrollment
  Used to add or drop dependents from insurance coverage due to a qualified family status change outside of the annual enrollment period (July of each year).  You may fill out this form online prior to printing.
   

Retirement Forms:

• ORP - Optional Retirement Plan (HR14)
  Salary Reduction Acknowledgement/Change of Vendor.  You may fill out this form online prior to printing.

• ORP and/or TDA Transfer Verification (HR16)
  You may fill out this form online prior to printing.

• TDA - Tax Deferred Annuity (HR17)
  Salary Reduction Agreement. You may fill out this form online prior to printing.

• Tax-Deferred Account Maximum Contribution Limit Worksheet (HR10)
  {This form replaces the MEA calculation worksheets for both ORP/TRS}

Miscellaneous Human Resources Publications and Forms

Emergency Communications - E2 Campus ● Emergency Response Plan