All EUTF Forms

Active Employees

Future Retirees

Retirees

Forms Index

Forms & Documents Index
Title
2024-25 EC-1 Enrollment Form
2024-25 EC-1H Enrollment Form for HSTA VB
2025-26 EC-1 Enrollment Form - Bargaining Units 11, 12, 14, 15
2025-26 EC-1 Enrollment Form - Bargaining Units 00, 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 13
2025-26 EC-1H Enrollment Form for HSTA VB
2025 EC-2 Enrollment Form
2025 EC-2H Enrollment Form
2024-25 Active Reference Guide
2025-26 Active Reference Guide - Rev 05.01.25
2025 Retiree Highlights Guide
ACH Deduction Authorization Agreement Form
ACH Deduction Cancellation Form
Address Change Form for Employees - Counties of Hawaii and Kauai Only
Address Change - All Employers Except for Counties of Hawaii and Kauai
Address Change Form for Retirees
Administrative Rules effective 10/10/2024
Affidavit for Collection of Personal Property
Appeal Form
Chapter 87A
Death 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
ERS Pension Deduction Authorization Form
ERS Pension Deduction Cancellation Form
EUTF Retiree Premium Worksheet (Retirees Hired Prior to 7/1/2001) - Effective 1/1/25 - 12/31/25
EUTF Retiree Premium Worksheet (Retirees Hired On or After 7/1/2001) - Effective 1/1/25 - 12/31/25
General Affidavit
HIPAA Authorization Form for Release of Protected Health Information
HSTA VB Retiree Premium Worksheet - Effective 1/1/25 - 12/31/25
L-1 Form - Authorized Leave of Absence Without Pay
Medicare Checklist
New Hire Enrollment Guide
Newborn Checklist
Premium Conversion Plan
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