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Immigration Rights and Resources for the Campus Community

Exercising Your Rights to Free Speech

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Forms - Benefits

DepartmentTitle/DetailsForm NumberDirect Link
HR2016 Open Enrollment - Health Plan Change Only Form
HRAuthorization to Transport Form
HRBenefit Enrollment Worksheet
HRBenefits Fair Flyer
Document
HRBiometric Screening Quick Guide
HRCAL-ORE Life Flight Membership Form
Document
HRCalPERS Beneficiary Designation Formhttp://www.humboldt.edu/hsuhr/docs/benedesignee.pdf
HRCalPERS Health Plan Benefit Comparison
HRCalPERS Member Reciprocal Self-Certification Formhttps://www.calpers.ca.gov/docs/forms-publications/self-certification.pdf
HRCareer Development Planhttps://apex.humboldt.edu/ords/f?p=244:3
HRCOBRA Rates for 2015
Document
HRCSU 403(b) form
HRCSU Fee Waiver Program Information https://www.humboldt.edu/hr/employee-benefits/fee-waiver
HRDefense of Marriage Act Updates
Document
HRDental Plan Enrollment Authorization
Document
csudentalform.pdf (849.86 KB)
Financial ServicesDirect Deposit for Accounts Payable Reimbursementshttps://link.humboldt.edu/ZG6
HRDomestic Partner Forms
HRDomestic Partner Information
HRe-Benefits Self-Service Electronic Signature Authorization Formhttps://humboldtas.na2.documents.adobe.com/account/requestSignatures?&workflowi…
HREmployee Assistance Program (EAP)
Document
eap0.pdf (518.35 KB)
HREmployee's Claim Form For Worker's Compensation Benefits
Document
dwc1.pdf (103.25 KB)
HRHCRA-DCRA Enrollment Form
HRHealth Care/Dependent/Care Reimbursement Account Claim Form
Document
claimform.pdf (518.28 KB)
HRHighlights of New Voluntary Plans
Document
HRHow Service Credit is Earned
Document
HRLetter/Options for Sanders Voluntary Insurances
HRPERS Declaration of Health Benefits
HRPre-Designation of Physician
Document
HRPregnancy Disability Certification
HRPrivacy Notice - Employee Assistance Program
Document
HRQuick Guide to Logging Your Steps
HRRequest for Service Credit - Service Prior to Membership
HRRetirement Information
Document
retirement.pdf (315.75 KB)
HRSaving Made Easy - 403(b) Information
Document
HRSavings Plus Benefits Payment Booklethttps://nationwidefinancial.com/media/pdf/NRM-4204CA.pdf?_ga=2.218510169.173832…
HRSelf Service Guide: My Benefit Enrollments
Document
HRSocial Security & Your Retirement
Document
seminarhsu.pdf (1.44 MB)
ResearchSPF Out of Area WC Procedures
Document
ResearchSPF TIAA-Cref Summary of Plan Services and Costs
Document
ResearchSPF Workers' Comp Guide
HRSupervisor's Report of Injury
Document
HRTSA Information
HRUniversal Availability Notice - 403(b) Plan Information
HRUniversal Availability Notice 2014
HRVSP Out-of-Network Reimbursement Form
HRVSP Video Display Terminal (VDT) Claim Form
HRVSP Vision Insurance Claim - No form required for vision services
HRW-4 - Employee's Witholding Allowance CertificateW-4http://www.irs.gov/pub/irs-pdf/fw4.pdf
HRWork-Related Injury Reporting Procedure
HRWorkers Compensation Pre-Designation of Physician Form