Certificate of Retirement Classified Signatory Service (Union Position)
Certificate of Retirement Non-Classified / Non-Signatory Service (Non-Union Position)
Certificate of Layoff (Layoff from Union Position)
Change of Address
Tax Withholding
Beneficiary Designation
Direct Deposit Enrollment
Request to Discontinue Direct Deposit
Request for withdrawal of Union dues from Pension check
Request for Hearing
Death Benefit Tax Election for an Estate or Organization
Death Benefits Tax Election for Applicants Who Are NOT an Estate or Organization
The list of forms below includes two of the most common medical forms used by physicians, hospitals and other facilities. It also includes other forms, such as for eye exams, mail order prescription drugs and change of address. If you do not see the form you are looking for, please call the Funds’ Call Center at: 1-800-291-1425
CMS 1500: Used for physician billing
UB04: Used for hospital, rehabilitation centers, surgery centers and clinic billing
Funds’ Medical Justification Form for:
Durable Medical and Respiratory Equipment
CMS Forms and Instructions:
CMS 846 – Pneumatic Compression Devices
CMS 847 – Osteogenesis Stimulators
CMS 849 – Seat Lift Mechanisms
CMS 10125 – External Infusion Pumps
CMS 10126 – Enteral and Parenteral Nutrition
CMS 854 – Continuation Form (for any of the above CMS forms)
