background 0background 1background 2background 3

Immigration Rights and Resources for the Campus Community

Breadcrumb

PERS Declaration of Health Benefits

Form:

Department: HR

Format: PDF

Routing Instructions:

Original form to Human Resources

Description:

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.

Category:

Benefit