EUTF Forms & Documents

Active Employees

Future Retirees

Retirees

Forms Index


Forms & Documents Index
Title
2017 Active Reference Guide
2017 Retiree Reference Guide
2017-18 EC-1 Enrollment Form ​(All Bargaining Units Except BU 12)
2017-18 EC-1 Enrollment Form​​ (Police Bargaining Unit 12 Only)
2017-18 EC-1H Enrollment Form for HSTA VB
2018 Active Reference Guide
2018 Retiree Reference Guide
2018-19 EC-1 Enrollment Form ​(All Bargaining Units Except BU 12)
2018-19 EC-1 Enrollment Form​​ (Police Bargaining Unit 12 Only)
2018-19 EC-1H Enrollment Form for HSTA VB
ACH Deduction Authorization Agreement Form
ACH Deduction Cancellation Form
Address Change Form for Employees
Address Change Form for Retirees
Administrative Rules
Appeal Form
Chapter 87A
Civil Union - Termination
Death Checklist
Disability Certification for Dependent Children
Domestic Partnership - Declaration and Tax Affidavit
Domestic Partnership - Termination
EC-2 Enrollment Form for Retirees
EC-2H Enrollment Form for Retirees
ERS Pension Deduction Authorization Form
ERS Pension Deduction Cancellation Form
EUTF Retiree Worksheet - Effective 1/1/18-12/31/18
General Affidavit
HIPAA Authorization Form for Release of Protected Health Information
HSTA VB Retiree Worksheet - Effective 1/1/18-12/31/18
Medicare Checklist
New Hire Enrollment Guide
Newborn Checklist
PCP Election Change Form (State of Hawaii Employees Only)
Pre-Retirement Checklist
Reimbursement of Medicare Part B Premiums ​(Direct Deposit Agreement Form)
Revised L-1 Form - Authorized Leave of Absence Without Pay with 2017 Rates
Revised L-1 Form - Authorized Leave of Absence Without Pay with 2018 Rates

Sample Documents

EUTF Student Certification Letter
Medicare Card
Medicare Part B Reminder Notice for Member Letter
Medicare Part B Reminder Notice for Spouse/Partner Letter
Medicare Part B Social Security Administration Verification Letter
Student Verification Letter