| Form Name |
Form Description |
| PEN-001
Retirement Declaration
|
Used by a retired ironworker whose pension has been approved states the rules on working. Must be signed and returned.
|
|
PEN-002
Disability Retirement Declaration
|
Used by an ironworker retiring on a Disability Pension – states the rules on working and must be signed and returned.
|
|
PEN-003
Retiree Work Application
|
Used by a retired ironworker who would like to return to work and continue to receive his/her pension. |
|
PEN-004
Pension Election Payment Form |
Used by a retired ironworker whose pension has been approved to elect either a single or husband and wife pension.
|
|
PEN-005
Electronic Deposit Authorization
|
This form is used by a retired ironworker who wishes to have his/her pension check electronically transferred to their bank account. |
|
PEN-006
Designation of Beneficiary |
Used by a retired ironworker whose pension has been approved to designate a beneficiary. |
|
PEN-007
Pension Tax Form |
This form is used by a retired ironworker receiving a pension check as a Federal and State Tax Deduction election. |
|
PEN-008
Retiree Premium Deduction Authorization
|
This form is used by a retired ironworker whose pension has been approved and who is eligible for the premium do be deducted from his/her pension check. |
|
ELG-001
Student Status Verification
|
This form is used by a dependent child(ren) between the ages of 21 year up to 24 years who are full time students (12 units or more) in an accredited college, university, or trade school. |
|
ELG-002
Disability Certificate
|
This form is used by an Ironworker who has been injured and will be unable to work for a specified period of time. By completing this form you may be entitled to an extension on your welfare coverage and/or additional pension credits. This form must be completed if you are intending to withdraw your Annuity Balance due to Total and Permanent Disability. |
ELG-016
Kaiser Permanente Election Form |
Kaiser Permanente Election Form |
|
CL-001
Active Fee-For-Service
|
Active Fee For Service Medical Benefit Plan Summary
|
|
CL-002
Retiree Fee-For-Service
|
Retiree Fee For Service Medical Benefit Plan Summary |
|
CL-010
Dental Fee Schedule
|
This Schedule is used to inform the members the covered services under the Fee For Service Dental Plan and amount that each service is covered up to. |
|
EMP-002
Missing Hours Investigation Request |
This form is used to report hours missing or not correctly reported by employers. A copy of your check stub must be attached to this form. Investigation will be made of your claim as soon as possible after receipt of the form and the Trust Office will then contact you. |
|
EMP-003
Report of Constructions Contractor's Wage Rates |
This form is used in lieu of WD-10 issued by the U.S. Department of Labor. The information requested is authorized under the Ironworkers Master Collective Bargaining Agreement. The identity of the respondent will be kept confidential to the maximum extent possible. |
|
VAC-001
Address Change |
This form is used by an Active Ironworker to change his/her address. This form must be mailed - we will not accept faxed or emailed copies. |
|
VAC-002
Vacation Electronic Deposit Authorization
|
This form is used by a member who wishes to have his/her vacation check electronically deposited to his/her bank account |
|
PEN-009
Pension Application
|
This form is used to begin the retirement process |
