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HSU Forms

Benefit

Form Number Title/Detailssort icon Department Direct Link To Form
Workers Compensation Pre-Designation of Physician Form Human Resources
W-4 W-4 - Employee's Witholding Allowance Certificate Human Resources

http://www.irs.gov/pub/irs-pdf/fw4.pdf

VSP Vision Insurance Claim - No form required for vision services Human Resources
VSP Video Display Terminal (VDT) Claim Form Human Resources
VSP Out-of-Network Reimbursement Form Human Resources
Vision Insurance - Add Dependents Human Resources

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

Universal Availability Notice 2014 Human Resources
Universal Availability Notice - 403(b) Plan Information Human Resources
Supervisor's Injury Prevention Report Contracts, Procurement and Risk Management
SPF Workers' Comp Guide Sponsored Programs Foundation
SPF TIAA-Cref Summary of Plan Services and Costs Sponsored Programs Foundation
SPF Out of Area WC Procedures Sponsored Programs Foundation
SPF Out of Area WC Procedures Sponsored Programs Foundation
SPF Investment Comparitive Chart Sponsored Programs Foundation
Social Security & Your Retirement Human Resources
Self Service Guide: My Benefit Enrollments Academic Personnel Services and Human Resources
Saving Made Easy - 403(b) Information Human Resources
Retirement Information Human Resources
Request for Service Credit - Service Prior to Membership Human Resources
Quick Guide to Logging Your Steps Human Resources
Pregnancy Disability Certification Human Resources
PERS Declaration of Health Benefits Human Resources
Open Enrollment 2014: News and Information Academic Personnel Services and Human Resources
Open Enrollment 2014: FAQ's Academic Personnel Services and Human Resources
Letter/Options for Sanders Voluntary Insurances Human Resources
How to Make Changes During Open Enrollment Human Resources
How Service Credit is Earned Human Resources
Highlights of New Voluntary Plans Human Resources
Health Care/Dependent/Care Reimbursement Account Claim Form Human Resources
HBD-12 Health Benefits Enrollment Form - (Medical Benefits worksheet) Human Resources
HCRA/DCRA 2014 Human Resources
Flex Cash Enrollment Authorization Form Human Resources
Fee Waiver Application-Dependent Academic Personnel Services and Human Resources

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

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

Employee's Claim Form For Worker's Compensation Benefits Human Resources
Employee Assistance Program (EAP) Human Resources
Domestic Partner Information Human Resources
Domestic Partner Forms Human Resources
Direct Deposit for Employee Reimbursements Financial Services
STD-692 Dental Plan Enrollment Authorization Human Resources
Defense of Marriage Act Updates Human Resources
CSU Fee Waiver Program Information Human Resources

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

Career Development Plan 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...

CalPERS Beneficiary Designation Form Human Resources

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

CAL-ORE Life Flight Membership Form Human Resources
Blue Shield Monthly Webinar (May) Human Resources
Biometrics Flyer Human Resources
Biometric Step by Step Guide Human Resources
Biometric Screening Quick Guide Human Resources
Benefit Enrollment Worksheet Human Resources
2015 Health Premiums Academic Personnel Services and Human Resources