City of Riverside, California - Human Resources Benefits - Benefit Forms

:: Benefit Forms

Anthem Blue Cross Forms

Kaiser Permanente

Delta Dental

DPO Claim Form

Deferred Compensation Forms

Great West Deferred Compensation Forms
Alternate Payee Distribution Form Automated Minimum Distribution Beneficiary Designation Catch-Up Application Form Change Form Death Benefit Claim Form Distribution/Direct Rollover/Transfer Electronic Fund Transfer ACH Form	Enrollment/Application Form Incoming Transfer/Direct Rollover Loan Payment Change Request Part Time Death Benefit Form Part Time Distribution Form Participant Distribution Guide Salary Deferral Agreement Suitability Profile Unforeseeable Emergency Withdrawal Request
ICMA Deferred Compensation Forms
401(a) Enrollment Form 401(a) Loan Packet 401 Plan Change Form 457 Enrollment/Change Form Beneficiary Claim Packet Beneficiary Designation Catch-Up Provision Packet Direct Deposit Emergency Withdrawal Packet	Loan Packet Payment Schedule Change 457/401 Service Credit Buyback Packet Special Tax Notice Transfer Out of ICMA Transfer Packet W4-P Withdrawal Packet

Leave Forms

Flexible Spending Plan Forms

Life Insurance/Long Term Disability

Retirement

Vision Service Plan (VSP)

Out-of-Network Reimbursement Form

Benefit Information

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QUESTIONS?

Contact the Human Resources
Benefits Division

Telephone: (951) 826-5639
Fax: (951) 826-2421
Email: Citybenefits@riversideca.gov

Monday-Friday . . . 8am-5pm PDT