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HSU Forms

Benefit

Form Numbersort icon Title/Details Department Direct Link To Form
VSP Vision Insurance Claim - No form required for vision services Human Resources
VSP Out-of-Network Reimbursement Form Human Resources
VSP Video Display Terminal (VDT) Claim Form Human Resources
Flex Cash Enrollment Authorization Form Human Resources
Health Care/Dependent/Care Reimbursement Account Claim Form Human Resources
CAL-ORE Life Flight Membership Form Human Resources
CalPERS Beneficiary Designation Form Human Resources

http://www.humboldt.edu/hsuhr/docs/benedesignee.pdf

Domestic Partner Information Human Resources
Domestic Partner Forms Human Resources
Supervisor's Injury Prevention Report Contracts, Procurement and Risk Management
Employee's Claim Form For Worker's Compensation Benefits Human Resources
Workers Compensation Pre-Designation of Physician Form Human Resources
CSU Fee Waiver Program Information Human Resources

http://www.humboldt.edu/hsuhr/employee/waiver/index.html

Direct Deposit for Employee Reimbursements Financial Services
Vision Insurance - Add Dependents Human Resources

http://humboldt.edu/hsuhr/employee/benefits/documents/VSP-Dependents.pdf

Highlights of New Voluntary Plans Human Resources
Letter/Options for Sanders Voluntary Insurances Human Resources
Fee Waiver Application-Dependent Academic Personnel Services and Human Resources

https://accountcenter.humboldt.edu:4443/p/r/f?p=137:10

Career Development Plan Human Resources
SPF Workers' Comp Guide Sponsored Programs Foundation
Retirement Information Human Resources
How Service Credit is Earned Human Resources
Request for Service Credit - Service Prior to Membership Human Resources
Employee Assistance Program (EAP) Human Resources
How to Make Changes During Open Enrollment Human Resources
PERS Declaration of Health Benefits Human Resources
Universal Availability Notice - 403(b) Plan Information Human Resources
SPF Out of Area WC Procedures Sponsored Programs Foundation
SPF Out of Area WC Procedures Sponsored Programs Foundation
Blue Shield Monthly Webinar (May) Human Resources
SPF Investment Comparitive Chart Sponsored Programs Foundation
SPF TIAA-Cref Summary of Plan Services and Costs Sponsored Programs Foundation
Defense of Marriage Act Updates Human Resources
HCRA/DCRA 2014 Human Resources
Social Security & Your Retirement Human Resources
Saving Made Easy - 403(b) Information Human Resources
Universal Availability Notice 2014 Human Resources
Benefit Enrollment Worksheet Human Resources
Pregnancy Disability Certification Human Resources
Quick Guide to Logging Your Steps Human Resources
Biometric Step by Step Guide Human Resources
Biometric Screening Quick Guide Human Resources
920 Fee Waiver Application - Faculty Self Academic Personnel Services

https://accountcenter.humboldt.edu:4443/p/r/f?p=137:11

925 Fee Waiver Application - Faculty Dependent Academic Personnel Services

https://accountcenter.humboldt.edu:4443/p/r/f?p=137:10

HBD-12 Health Benefits Enrollment Form - (Medical Benefits worksheet) Human Resources
PERS-CASD-801 CalPERS Member Reciprocal Self-Certification Form Human Resources

http://www.calpers.ca.gov/eip-docs/about/pubs/employer/er-forms/ret-form...

STD-692 Dental Plan Enrollment Authorization Human Resources
W-4 Employee's Witholding Allowance Certificate Human Resources