EUTF Forms
For Open Enrollment 2012
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EC-1 Active Print and Fill Form "Effective January 1, 2012" Dec 30, 2011
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EC-2 Retiree Print and Fill Form "Effective January 1, 2012" Dec 30, 2011
Must be used for events occurring on or before December 31, 2011
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EC-1 Print and Fill Form for use up to December 31, 2011 Jul 08, 2011
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EC-2 Print and Fill Form for use up to December 31, 2011 Aug 1, 2010
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2011 Retiree 0%, 50%, 75% Worksheet - Effective July 1, 2011 Jul 05, 2011
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Authorized Leave of Absence without Pay Jul 20, 2011
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PCP Election Change Form (State of Hawaii Employees Only) Link to DHRD Premium Conversion Plan Forms Effective Jul 1, 2008
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Direct Deposit Authorization Print and Fill Form Effective Jul 1, 2007
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Authorization for Release of Protected Health Information Print and Fill Form
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Civil Union Forms Dec 30, 2011
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Active EUTF COBRA Election Form Jan 31, 2011
