Skip to secondary navigation
Skip to content

HSU Forms

PERS Declaration of Health Benefits

Form: 
application/pdf iconPERS Declaration of Health HBD12A.pdf
Department: 
Human Resources
Format: 
PDF
Routing Instructions: 
Original form to Human Resources

Complete this form in addition to the HBD-12, Health Benefit Election form. Both forms must be submitted to HR for a benefit transaction to occur.

Last Updated:  Tue, 10/30/2012 - 14:48
Categories: