Benefits » Forms and Publications

Forms and Publications

• Awards
• COBRA Information Sites and Forms
• Domestic Partnership
• Family and Medical Leave
• Health and Insurance
• Miscellaneous Forms
• Payroll

Awards

• Contract Worker Award Nomination Form (pdf)
• Cover Sheet for Individual Distinguished Performance Award Nomination (1831) (pdf)
• Cover Sheet for Large Team Distinguished Performance Award Nomination (1833) (pdf)
• Cover Sheet for Small Team Distinguished Performance Award Nomination (1832) (pdf)
• Employee Referral Incentive Authorization (1749) (pdf)
• Justification for Hire-On Incentive (1748) (pdf)
• Los Alamos Awards Program (LAAP) (1794) (pdf)
• Spot Nomination Form (1795) (pdf)
• Service Award Funding Request (1762) (pdf)

COBRA Information Sites and Forms:

• Health Care Benefits Under COBRA (pdf)
• Cobra Consolidated Omnibus Budget Reconciliation
• Departpartment of Labor - COBRA

Domestic Partnership

• Declaration of Domestic Partnership (1925a) (pdf)
• Domestic Partner: Termination of (1925c) (pdf)

Family and Medical Leave

• Certification of Health Care Provider (1786) (pdf)
• Designation of Family Medical Leave (1784) (pdf)
• Designation of Family and Medical Leave by Manager (1787) (pdf)
• Employee Request for Family and Medical Leave(1621) (pdf)
• Family and Medical Leave Notification (1785) (pdf)

Health and Insurance

• Beneficiary Designation/Change Form (1938) (pdf)
• Blue Cross of California website (pdf)
• Core Insurance Enrollment Form (1760) (pdf)
• Delta Dental Claim Form (pdf)
• Dependent Care/HCRA Enrollment Agreement (1922) (pdf)
• Dependent Care/HCRA/TIPS Change or Cancellation Agreement (1924) (pdf)
• For 2007 claims, Dependent Care Reimbursement Account Form (pdf)
• For 2007 claims, HealthCare Reimbursement Account Form (pdf)
• Full-Level Insurance Enrollment Form (1751a) (pdf)
• Mid-Level Enrollment Form (pdf)
• MedCo Pharmacy Mail Order Form (pdf)
• Medco Prescription Drug Reimbursement Claim Form (pdf)
• UHC Select EPO Claim Form (pdf)
• UHC International Claim Form (pdf)
• UHC Flexible Spending Account Claim Form (pdf)

Miscellaneous Forms

• Housing Request Form (1814) (pdf)
• IRS Forms & Publications
• LANL Employment/Affiliation Confirmation (1848) (pdf)
• Request for Community Service Time (704) (pdf)
• Request for Reimbursement from Employee Morale Fund (1763) (pdf)
• Social Security Forms
• Tuition Waiver Form (pdf)

Payroll

• Payroll Forms

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