Department of Human Resources: Benefits Forms for Employees Hired before October 1, 1987
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Benefits Forms for Employees Hired before October 1, 1987

Form # Title
  Flexible Spending Account*
  Pre-Tax Waiver/Election Form*
SF 2817 Life Insurance Election*
SF 2819 Notice of Conversion Privilege, Federal Employees
Group Life Insurance Program*
SF 2820 Certification of Insured Employee's Retired Status*
SF 2822 Request for Insurance*
SF 2823 Designation of Beneficiary, Federal Employees
Group Life Insurance Program*
FE 6 Claim for Death Benefits, Federal Employees
Group Life Insurance Program*
FE 6 DEP Settlement of Claim, Option C: Family Life Insurance*
Retirement Computation Form*
FE 7 Claim for Accidental Means Dismemberment Benefits*


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