Please choose the appropriate form(s) that you require.

All forms are in PDF format, and require Adobe Acrobat Reader.

Local	File Description	Form
Generic Forms	Change of Address	Click Here
	Medical Claim Form	Click Here
	Dental Claim Form	Click Here
	W-9 Form	Click Here
Local 300 SEIU AFL-CIO Welfare Fund	Vision care claim reimbursement form	Click Here
	Podiatry Benefit –Active Members	Click Here
United Staff Associates Welfare Fund	Change of address form	Click Here
	Medical/Miscellaneous Benefit Claim Form	Click Here
	Optical-Hearing Aid Claim Form	Click Here
	Variable Benefit Claim Form	Click Here
	Dental Claim Form	Click Here
Dobbs Ferry United Teachers	Benefit Claim Form	Click Here
East Williston Teachers Association	Dental Claim Form	Click Here
	Hearing Aid Claim Form	Click Here
	Prescription Claim Form	Click Here
	Supplemental Optical Form	Click Here
Faculty Association Suffolk Community College	Prescription Claim Form	Click Here
Great Neck Teachers Association Benefit Trust Fund	Prescription Claim Form - Active	Click Here
	Excess Medical Benefit Form - Active	Click Here
	Excess Medical Benefit Form - Retiree	Click Here
	Prescription Claim Form - Retiree	Click Here
Local 891 International Union of Operating Engineers	Plan “A” Optical Claim Form	Click Here
	Prescription Claim Form	Click Here
New York State Court Clerks Association	Optical Claim Form	Click Here
United Teachers of Seaford	Optical Variable Form	Click Here
Wappingers Congress of Teachers	Hearing Aid Claim Form	Click Here
	Prescription Claim Form	Click Here
Manhasset Education Association	Dental Claim Form	Click Here
	Optical Form	Click Here
	Supplemental Form	Click Here
CWA 1180	Dental Claim Form	Click Here