(At Your Service Web Site)
(ph: 1-866-682-7787)Benefits Forms and Publications
If you have any questions, or are unable to locate a benefit form, please call the Berkeley Lab Benefits Hotline at (510) 486-6403.
This site contains frequently used forms at the Berkeley Lab. Additional forms can be found on the At Your Service forms page.
**Many of the Forms in this section are saved in the Acrobat Reader format. In order to properly read and print them, you may need to download the reader directly from Adobe's Acrobat Reader site.
Health & Life Insurance Plan Forms
- Designation of Beneficiary
- Benefits Enrollment, Change, Cancellation or Opt-Out form (UPAY 850)
- Family Changes Checklist
Medical & Dental Claim Forms
Retirement Plan Forms
- Declaration of Domestic Partnership
- Designation of Beneficiary (for UC Retirement System)
- Termination of Domestic Partnership
Flexible Spending Accounts
- Dependent Care Flexible Spending Account (DepCare FSA)
- Health Flexible Spending Account (Health FSA)
