ACRE Enrollment Form |
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ACRE and REAC Membership Termination Form |
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Active or Deferred Member Beneficiary Designation Form |
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Address and Name Change Form (Retirees, Payees, and Deferred Members) |
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Affidavit of Dependent Eligibility |
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Affidavit of Domestic Partnership |
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Agreement and Order for Division of Retirement Benefits – Separate Records |
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Agreement and Order for Division of Retirement Benefits – Shared Records |
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Application For Disability Retirement (Sample Only) |
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Application for Service Retirement |
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Aquilino Tier 1 Restoration Application |
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Authorization for Release of Information and Documents |
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Community Property Estimate Request Form |
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Continuance Beneficiary Addendum |
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Declaration of Qualification for Registration as Domestic Partners |
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Dental Plan Enrollment Form |
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Direct Deposit Form |
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Disability |
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HIPAA Authorization Form |
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HIPAA Cancellation Form |
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IRS Form W-9 |
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Kaiser Permanente Senior Advantage (KPSA) Enrollment Form |
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Lump-Sum Death Benefit Beneficiary Addendum |
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Medical Plan Enrollment Form |
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Medicare Part B Reimbursement Plan (MBRP) Application Form |
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Member Enrollment Questionnaire |
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Non-Member Application for Retirement Allowance |
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Non-Member Beneficiary Form |
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Notice of Claim |
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Other Public Service Verification Form |
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Power of Attorney |
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Purchase Request Form |
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Purchase Request Form FAQ |
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REAC Enrollment Form |
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Report a Death Form |
Web Form |
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Request for Joinder Packet |
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Retired Member Beneficiary Designation Form |
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Retirement Estimate Request Form |
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Retirement Payment Option Addendum |
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SSA-44 Form (Medicare Income-Related Monthly Adjustment Form) |
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Survivor Continuance Recipient’s Designation of Beneficiaries Form |
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Tax Withholding Designation Form (IRS Federal Form W-4P) |
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Tax Withholding Designation Form (State of California) |
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Termination Election of Membership Request Form |
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Termination of Domestic Partnership |
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Verification of Enrollment Status |
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Via Benefits Reimbursement Forms |
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Vision Plan Enrollment Form |
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VSP Reimbursement Forms: Login at VSP website |
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