Forms

Forms

Form Name Description Form Category Download
401(k) QDRO Form Model 401K
Application for Beneficiaries Contact the Fund Office at 1-800-474-8673 to request an application. Pension Plan
Application for Pension Contact the Fund Office at 1-800-474-8673 to request an application. Pension Plan
Application for Spouse of Pre-Retirement Employee Contact the Fund Office at 1-800-474-8673 to request an application. Pension Plan
Authorization Agreement for Direct Payments MassMutual's form for automatic Loan Payments 401K
Beneficiary Designation Form for adding a beneficiary 401K
Catch up Contribution Change Form Election form participants 50 or over who can contribute additional funds over standard IRS limit 401K
Certificate of Creditable Coverage Form for continuation of coverage HRA
Change in Age for Children Form for dependent chilrden age 19-26 HRA
Change of Address Form to update Fund Office of current address 401K, HRA, Pension Plan
Claim Form HRA
Claim Form - Recurring and Third Party To file for recurring claims payable to a third party HRA
Continued Coverage for Disabled Child HRA
Dependent Change Form Form to add dependents HRA
Direct Deposit Authorization Package Form to elect or change direct deposit information for pension payments 401K, HRA, Pension Plan
Form W-9 IRS form W-9 to provide correct tax payer identification number (i.e. Social Security Number) Pension Plan
Form W4P IRS form to elect or change tax withholding Pension Plan
HRA - Opt Out Form HRA
HRA -Attestation Form HRA
HRA Enrollment Form HRA
HRA Forms Please find HRA Forms on the HRA Account Login Page. To get there, hover over the LOGIN menu option and select HRA Account Login. HRA
HRA Major Medical Coverage Attestation Form HRA
Information Release Form Authorization for information release (used for pension application). Pension Plan
Legal Name Change Form HRA
PHI Release Form Authorization to release personal health information HRA
Savings Contribution Form Form to specify or change rate contribution 401K
Spanish - Beneficiary Designation Form for adding a beneficiary. 401K
Spanish - Savings Contribution Form Form to specify or change rate contribution 401K
Waiver of QPSA Form for participant's spouse to waive rights to the preretirement survivor annuity 401K
Withdrawal Liability Estimate Request Information for participating employers about requesting a withdrawal liability estimate. Pension Plan

Homepage - Announcements

Welcome to the Fund Office!