In response to COVID-19, the Fund Office is closed, with limited staff performing essential functions remotely. The Fund Office has activated its business continuity plan to continue to provide service to our participants and participating employers during this situation. Please see the Fund-specific information below.

Pension Fund – Pension payments will continue to be made as scheduled. Current payees may experience delays when updating an address or direct deposit information. Applications for benefits will continue to be processed but there may be some processing delays. 

USW 401(k) – Contributions are continuing to be processed daily.

USW HRA Fund – Claims are continuing to be reviewed. If the review cannot be completed in 30 days, the Fund will notify participants of the need to extend an additional 15 days.

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
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
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

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