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HSU Forms

Benefit

Form Number Title/Detailssort icon Department Direct Link To Form
2013 FSA Grace Period Human Resources
Blue Shield Monthly Webinar (May) Human Resources
CAL-ORE Life Flight Membership Form Human Resources
Cal-Ore Life Flight Membership Program Human Resources
CalPERS Beneficiary Designation Form Human Resources

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

Career Development Plan Human Resources
CSU Fee Waiver Program Information Human Resources

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

STD-692 Dental Plan Enrollment Authorization Human Resources
Direct Deposit for Employee Reimbursements Financial Services
Domestic Partner Forms Human Resources
Domestic Partner Information Human Resources
Employee Assistance Program (EAP) Human Resources
Employee's Claim Form For Worker's Compensation Benefits Human Resources
W-4 Employee's Witholding Allowance Certificate Human Resources
Flex Cash Enrollment Authorization Form Human Resources
HBD-12 Health Benefits Enrollment Form - (Medical Benefits worksheet) Human Resources
Health Care/Dependent/Care Reimbursement Account Claim Form Human Resources
Highlights of New Voluntary Plans Human Resources
How Service Credit is Earned Human Resources
How to Make Changes During Open Enrollment Human Resources
Letter/Options for Sanders Voluntary Insurances Human Resources
Open Enrollment Letter for 2012 Human Resources
PERS Declaration of Health Benefits Human Resources
Request for Service Credit - Service Prior to Membership Human Resources
Retirement Information Human Resources
SPF Investment Comparitive Chart Sponsored Programs Foundation
SPF Out of Area WC Procedures Sponsored Programs Foundation
SPF Out of Area WC Procedures Sponsored Programs Foundation
SPF TIAA-Cref Summary of Plan Services and Costs Sponsored Programs Foundation
SPF Workers' Comp Guide Sponsored Programs Foundation
Staff Fee Waiver-Dependent Human Resources
Supervisor's Injury Prevention Report Contracts, Procurement and Risk Management
Universal Availability Notice - 403(b) Plan Information Human Resources
Vision Insurance - Add Dependents Human Resources

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

VSP Out-of-Network Reimbursement Form Human Resources
VSP Video Display Terminal (VDT) Claim Form Human Resources
VSP Vision Insurance Claim - No form required for vision services Human Resources
Workers Compensation Pre-Designation of Physician Form Human Resources