Privacy & Security Notice    

     

Forms For Retired Participants

 

      
                Welcome to the Forms page for Retired Participants.  Select the appropriate form from the table below.  The forms are listed in alphabetical order.  After READING ALL INSTRUCTIONS, fill out the form, and return it to the appropriate party.
       

Employees

    

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  EMPLOYEE PLAN INFO   RETIREE PLAN INFO   PENSION/SAVINGS INFO
 
 
  Form Name / Description
  AUTOMATED CLEARING HOUSE (ACH) FORM NEW- Tired of writing a check every month for your insurance premiums? You can now have your Medical and Life Insurance premiums automatically deducted from your checking or savings account.  THIS FORM IS NOT INTENDED FOR ACTIVE EMPLOYEES!
  BENEFICIARY DESIGNATION FORM - If you are updating this form as a result of a life event (marriage, death, divorce, etc.) please contact and notify benefits administration via email at *Benefits.  PLEASE READ THE INSTRUCTIONS PRIOR TO FILLING OUT THE FORM!
  BENEFICIARY DESIGNATION FORM INSTRUCTIONS
  CHANGE OF ADDRESS - This form can be completed to notify us of your new address.
  DIRECT DEPOSIT AUTHORIZATION FORM (PENSION) - This form allows you to change/authorize your direct deposit information. 
  DIRECT DEPOSIT CANCELLATION FORM (PENSION) - Fill out this form if you would like to cancel direct deposits of your monthly pension.
  HANFORD RETIREE ASSOCIATION MEMBERSHIP FORM - Become a member of the Hanford Retiree Association.
  MEDICAL ENROLLMENT FORM
  PENSION W4P FORM - change your W4 information.
  REQUEST TO CHANGE MEDICAL COVERAGE - only available during open enrollment.
  UNITEDHEALTHCARE CLAIM FORM - Medical claim form for participants of UnitedHealthcare plans.
     

Send questions or comments to: mailto:benefits_-_hewt@rl.gov
 
 
 
 
 
 
 
 
 

Retirees

  
 
 
 
 
 

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