Forms

403(b) Annuity Program

• Annuity Cancellation Form
• List of 403(b) EPISD Authorized Agents
• Payroll Authorization Form

EPISD Employee Benefits

• Catastrophic Sick Leave Bank
• Change of Beneficiary Form

EPISD Health Care Trust Medical Plan Forms

• Lifestyle Reimbursement Program Application Form
• Lifestyle Reimbursement Program Attendance Log

EPISD Health Resource Center

• Health Center Closed Afternoon of June 20th
• Health Resource Center Schedule
• Patient Registration Form

Flexible Benefit Plan Forms

• Flexible Benefit Plan Claim Form
• Flexible Benefit Plan Claim Form - Medical
• Flexible Benefit Plan Dependent Care Claim Form

ING Life Insurance Forms

• Death Benefits Claim Form
• Evidence of Insurability Form

Leave Management Forms

• Family Medical Leave (FMLA) Request Form

Safeguard Dental Forms

• Claim Request Form

UNUM Disability Forms

• Disability Claim Form
• Medical Treatment Claim Form