Benefits Forms | Human Resources

Benefits Forms

403(b) Salary Reduction Agreement

457 (b) Salary Reduction Agreement

Application for Refund of Contributions-TRS

Application for Refund of Contributions - GA Defined Contribution Plan

Blue Cross Blue Shield Medical Claim Form

Regents Basic & Supplemental Life (CIGNA) Beneficiary Form

Regents Dental (MetLife) Claim Form

Critical Illness Enrollment Application

Delta Dental Claim Form

Dependent Care Flexible Spending Account Claim Form

Fidelity (403b) Enrollment Application

Health Care Flexible Spending Account Claim Form

Long Term Care Enrollment Application

Shared Leave Donation Form

Shared Leave Physician Certification

Shared Leave Request Form

TAP Application (Fulltime Employees)

TAP Application (PT Nursing Faculty)

Vision Claim Form

Contact Us

Human Resources Department
3251 Panthersville Rd.
Suite 2500
Decatur, GA 30034
Phone: 678-891-2500
Fax: 678-891-2511

Email Support: helpdesk@ssc.usg.edu
Web Support: www.ssc.usg.edu