Welcome to the Fund Office website. 

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
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
Empower Acquisition Disclosure 401K
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 - Attestation Form 2022 HRA
HRA - Opt Out Form HRA
HRA -Attestation Form 2017 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
Information Release Form Authorization for information release (used for pension application). Pension Plan
Insurance Premium Reimbursement Claim Form HRA
Legal Name Change Form HRA
PHI Release Form Authorization to release personal health information HRA
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

USW HRA: Summary of Material Modifications 3.17.2021 Now Available

Click Here

Welcome to the Fund Office!

PLEASE BE AWARE: Maintenance on the USWBF website will start at 1pm on Thursday 10/6. Once maintenance commences, file transfers and the HRA page will be unavailable until Firday morning 10/7. 

USW Benefit Funds comprises three Taft-Hartley Trusts:

  • The PACE Industry Union-Management Pension Fund (PIUMPF)
  • The USW Industry 401(k) Fund
  • The USW HRA Fund

Each Fund is governed by a Board of Trustees with both labor and management. All must be negotiated and must be included in the collective bargaining agreement.