Employer Forms

Authorization for ACH Debits

Employer Accounting of Member Compensation

Employer Certification Of Member Enrollment

Employer Information Form

Model Pick-Up Resolution for employers with existing pick-up plans

Model Pick-Up Resolution for employers who do not currently participate in a pick-up plan

New Member Information Form

Members Medical Questionnaire and Physicians Certification

Pre-Employment Physical Requirements

Work History Report

Employer Payment Remittance

Statement Concerning Your Employment in a Job Not Covered by Social Security