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Employee Benefit Forms

Health Care Coverage


Humana Medical Forms

Delta Dental Enrollment/Change Form

Delta Dental Claim Form

Extended Family Member Form



Flexible Spending Account


FSA Application 

Limited FSA Application

Electronic Funds Transfer Form

Qualified Status Change Form

FSA Medical Claim Form

Limited FSA Medical Claim Form

Certification of Medical Necessity

Dependent Care Acknowledgement 

Day Care Request For Reimbursement Form



Insurance 

Short-Term Disability Enrollment

Long-Term Disability Enrollment



Leave of Absence

LOA Request Form

LOA Information Release Form

Family Medical Leave Act Form

 


 

Employee Assistance  

Employee Information Form

Direct Deposit Authorization

Tuition Waiver Form

Transfer Vacation to Sick Leave Form

Holiday Hours Worked Form



Retirement

TIAA-CREF

Enrollment Information

Notice of Name Change Form

Authorization of Lifetime Annuity

Designation of Beneficiary Form

Transfer/Rollover Authorization

KY DCP

Participation Agreement Form

Designation of Beneficiary Form 

KERS

Membership Information Form

Designation of Beneficiary Form

Advice of Personnel Action Form

 

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