All EUTF Forms

Active Employees

Future Retirees

Retirees

Forms Index

Forms & Documents Index
Title
2021-22 EC-1 (Non-Ratified BU's) Enrollment Form
2021-22 EC-1 (Ratified BU's) Enrollment Form
2021-22 EC-1H Enrollment Form for HSTA VB
2021 EC-2 Enrollment Form
2021 EC-2H Enrollment Form
2022 EC-2 Enrollment Form
2022 EC-2H Enrollment Form
2021-22 Active Reference Guide
2021 Retiree Highlights Guide
2022 Retiree Highlights Guide
ACH Deduction Authorization Agreement Form
ACH Deduction Cancellation Form
Address Change Form for Employees
Address Change Form for Retirees
Administrative Rules
Affidavit for Collection of Personal Property
Appeal Form
Chapter 87A
Death Checklist
Department of Education (DOE) Retirement Checklist
Direct Deposit Agreement Form (Reimbursement of Medicare Part B Premiums)
Disability Certification for Dependent Children
Domestic Partnership - Declaration and Tax Affidavit
Domestic Partnership - Required Verification Documents
Domestic Partnership - Termination
ERS Pension Deduction Authorization Form
ERS Pension Deduction Cancellation Form
EUTF Retiree Premium Worksheet (Retirees Hired Prior to 7/1/2001) - Effective 1/1/21 - 12/31/21
EUTF Retiree Premium Worksheet (Retirees Hired On or After 7/1/2001) - Effective 1/1/21 - 12/31/21
General Affidavit
HIPAA Authorization Form for Release of Protected Health Information
HSTA VB Retiree Premium Worksheet - Effective 1/1/21 - 12/31/21
L-1 Form - Authorized Leave of Absence Without Pay
Medicare Checklist
New Hire Enrollment Guide
Newborn Checklist
Open Enrollment Checklist
PCP Election Change Form (State of Hawaii Employees Only)
Pre-Retirement Checklist
Sample Documents
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