California Public Employees' Retirement System Forms

127
total templates

Documents

127

Form HBD-12 "Health Benefits Plan Enrollment for Active Employees" - California

Rate (4.3 / 5) 110 votes
Size: 371 KB
3 pages

Form HBD-30 "Health Benefits Plan Enrollment for Retirees and Survivors" - California

Rate (4.3 / 5) 6 votes
Size: 349 KB
3 pages

Form PERS-BSD-35 "Authorization to Disclose Protected Health Information" - California

Rate (4.8 / 5) 63 votes
Size: 61 KB
2 pages

Form PERS-BSD-92 "Workers' Compensation Carrier Request" - California

Rate (4.5 / 5) 90 votes
Size: 117 KB
3 pages

Form PERS-HBD-85 "Group Continuation Coverage (Cobra)" - California

Rate (4.3 / 5) 11 votes
Size: 1 MB
3 pages

Form HBD-34 "Medical Report for the CalPERS Disabled Dependent Benefit" - California

Rate (4.6 / 5) 13 votes
Size: 146 KB
3 pages

Form HBD-98 "Member Questionnaire for the CalPERS Disabled Dependent Health Benefit" - California

Rate (4.4 / 5) 48 votes
Size: 137 KB
2 pages

Form PERS-HBD-21 "Direct Payment Authorization" - California

Rate (4.8 / 5) 31 votes
Size: 141 KB
3 pages

Form HBD-40 "Affidavit of Parent-Child Relationship" - California

Rate (4.8 / 5) 57 votes
Size: 138 KB
4 pages

Instructions for Form HBD-30 "Health Benefits Plan Enrollment for Retirees and Survivors" - California

Rate (4.7 / 5) 34 votes
Size: 93 KB
1 page

Instructions for Form HBD-12 "Health Benefits Plan Enrollment for Active Employees" - California

Rate (4.8 / 5) 15 votes
Size: 118 KB
1 page

Form PERS-EAMD-139 "Notice of Exclusion From CalPERS Membership for Public Agency and Schools" - California

Rate (4.3 / 5) 82 votes
Size: 1 MB
2 pages

Form PERS-BSD-194 "Report of Separation and Advance Payroll Information" - California

Rate (4.6 / 5) 30 votes
Size: 61 KB
2 pages

Form PERS-MSD-371 "Request for Service Credit Cost Information - Leave of Absence" - California

Rate (4.8 / 5) 122 votes
Size: 181 KB
4 pages

Form PERS-MSD-373 "Request for Service Credit Cost Information - Peace Corps, Americorps Vista, or Americorps Service Credit" - California

Rate (4.7 / 5) 41 votes
Size: 128 KB
2 pages

Form PERS-MSD-370 "Request for Service Credit Cost Information - Service Prior to Membership" - California

Rate (4.4 / 5) 35 votes
Size: 321 KB
5 pages

Form PERS-BSD-145 "Reinstatement From Service Retirement Application" - California

Rate (4.3 / 5) 94 votes
Size: 66 KB
2 pages

Form PERS-BSD-470 "Retirement Allowance Estimate Request" - California

Rate (4.5 / 5) 109 votes
Size: 113 KB
3 pages

Form PERS-MSD-353 "Tier Conversion Cost Information Request" - California

Rate (4.5 / 5) 83 votes
Size: 109 KB
2 pages

Form PERS-MSD-369 "Request for Service Credit Cost Information - Military Service" - California

Rate (4.7 / 5) 100 votes
Size: 132 KB
2 pages

Form PERS-MSD-372 "Request for Service Credit Cost Information - Layoff, Prior Service, and Optional Member Service" - California

Rate (4.4 / 5) 40 votes
Size: 341 KB
7 pages

Form PERS-MSD-374 "Request for Service Credit Cost Information - Base Realignment and Closure (Brac) Firefighter" - California

Rate (4.5 / 5) 91 votes
Size: 123 KB
2 pages

Form PERS-OSS-138 "Special Power of Attorney" - California

Rate (4.4 / 5) 54 votes
Size: 125 KB
6 pages

Form PERS-EAMD-801 "Reciprocal Self-certification Form" - California

Rate (4.3 / 5) 7 votes
Size: 1 MB
5 pages

Form HBD-85R "Cobra Election Form (Retirees)" - California

Rate (4.3 / 5) 94 votes
Size: 139 KB
2 pages

Form PERS-EAMD-139S "Notice of Exclusion From CalPERS Membership for State Agencies" - California

Rate (4.6 / 5) 117 votes
Size: 1 MB
2 pages