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Forms And Documents
Files are in downloadable PDF format and require Adobe Reader.
Triple S Card Reader Driver
| Topic | Form Name | Description |
|---|---|---|
| Health & Welfare | Annual Physical and Hearing Aid Claim Form | |
| Health & Welfare | Appointment of Personal Representative | |
| Health & Welfare | ASO Dental Claim Form | |
| Health & Welfare | Blue Cross Health Insurance Claim Form | |
| Health & Welfare | Caremark Mail Order Form | |
| Health & Welfare | Caremark Reimbursement Form | |
| Health & Welfare | Combined Capp Account Request Form | |
| Health & Welfare | Credit Card Authorization Form | |
| Health & Welfare | Davis Vision Out of Network Claim Form | |
| Health & Welfare | Dental Claim Form | |
| Health & Welfare | Dependent Election Form | |
| Health & Welfare | Designation of Beneficiary | |
| Health & Welfare | Medicare Waiver Form & Instructions | |
| Health & Welfare | Missing Contribution Form | |
| Health & Welfare | Plan A to Plan C Redirection Form | |
| Annuity | Beneficiary Designation Worksheet | |
| Annuity | Deferred Salary Agreement Form 401(k) | |
| Annuity | Missing Contribution Form | |
| Pension | Direct Deposit Form | |
| Pension | Missing Contribution Form | |
| Pension | Pension Beneficiary Form | |
| Vacation | Direct Deposit Form | |
| Vacation | Missing Contribution Form | |
| Vacation | Vacation Beneficiary Form | |
| Booklets/Documents | HW Triple S SPD | |
| Booklets/Documents | IATSE HW Plan A SPD | |
| Booklets/Documents | IATSE HW Plan C SPD | |
| Booklets/Documents | IATSE Pension Plan B SPD | |
| Booklets/Documents | IATSE Pension Plan C SPD | |
| Booklets/Documents | IATSE Vacation Fund SPD | |
| Contracts & Contributions | Contribution Remittance Form | |
| Contracts & Contributions | Deferred Salary Agreement Form | |
| Contracts & Contributions | Employer Contributions and Collections Guidebook | |
| Contracts & Contributions | IANBF Home Plan | |
| Contracts & Contributions | IANBF Home Plan for Local 600 Puerto Rico Only | |
| Contracts & Contributions | IANBF Home Plan for USA829 Only | |
| Contracts & Contributions | Multi-Fund Trust Acceptance Document | |
| Contracts & Contributions | Notice - End of Year Reports - All Years | |
| Contracts & Contributions | Notice re CAPP Rate as Contribution Rate | |
| Contracts & Contributions | Participation Agreement - Annuity Deferral - 3% | |
| Contracts & Contributions | Participation Agreement - Annuity SM Deferral | |
| Contracts & Contributions | Plan A to Plan C Redirection Form | |
| Agreement & Declarations of Trusts | First Amendment Health & Welfare Declaration of Trust | |
| Agreement & Declarations of Trusts | Health & Welfare Declaration of Trust | |
| Contracts & Contributions | Multi-Fund Participation Agreement | |
| Health & Welfare | Notice to Employers Regarding Compliance with ACA | |
| Agreement & Declarations of Trusts | Annuity Fund Declaration of Trust | |
| Agreement & Declarations of Trusts | Vacation Declaration of Trust | |
| Health & Welfare | Employer Mandate ACA | |
| Health & Welfare | MetLife Disability Claim Form - Plan A Only | |
| All | Trust Acceptance Document | |
| General | Change of Address Census Card | |
| Health & Welfare | MRP IRS Updated Regulations Notice | |
| Health & Welfare | Health & Welfare Plan C Eligibility Wheel | |
| General | Company Data Sheet | |
| Agreement & Declarations of Trusts | Second Amendment Health & Welfare Declaration of Trust | |
| Health & Welfare | MetLife - Participant Life Insurance Claim Form | |
| Annuity | Annuity Fund Plan Document | |
| Agreement & Declarations of Trusts | Second Amendment - Pension Fund Declaration of Trust | |
| Pension | Pension Plan B Document | |
| General | Refund Policy and Company Data Sheet | |
| Agreement & Declarations of Trusts | Second Amendment Annuity Fund Declaration of Trust | |
| Health & Welfare | ACA Certification for MRP | |
| Pension | Pension Plan C Document | |
| Pension | Annual Funding Notice for 2013 - Pension Fund | |
| Agreement & Declarations of Trusts | Pension Fund Agreement and Declaration of Trust | |
| Health & Welfare | Davis Vision C3/C4 Discount Brochure | |
| Annuity | First Amendment - Annuity Fund Plan Document | |
| Booklets/Documents | Health & Welfare Retiree Only Medical Reimbursement SPD - 2019 | |
| Pension | Annual Funding Notice for 2014 - Pension Fund | |
| Annuity | Second Amendment - Annuity Fund Plan Document | |
| Health & Welfare | New Medical Reimbursement Claim Form (MRP) | |
| Annuity | Third Amendment - Annuity Fund Plan Document | |
| Pension | Pension Estimate Request | |
| Annuity | Fourth Amendment - Annuity Fund Plan Document | |
| Annuity | Fifth Amendment - Annuity Fund Plan Document | |
| Health & Welfare | MRP Claims Direct Deposit Form | |
| Annuity | Sixth Amendment - Annuity Fund Plan Document | |
| Pension | Annual Funding Notice for 2017 - Pension Fund | |
| Booklets/Documents | IATSE Annuity Fund SPD | |
| Contracts & Contributions | Multi-Fund Trust Acceptance Document | |
| Pension | Annual Funding Notice for 2016 - Pension Fund | |
| Pension | FASB Financial Statement Disclosure for 2018 | |
| Health & Welfare | CAPP Rate Notice for Quarter Beginning October 1, 2020 | |
| Health & Welfare | Plan Updates to ABA Therapy and Disabled Dependent Children - June 2017 | |
| Health & Welfare | Medical Reimbursement Program (MRP) Mileage Worksheet | |
| Health & Welfare | Plan C - Medical Reimbursement Program (MRP) Reminder Notice | |
| Health & Welfare | Retiree-Only Medical Reimbursement Program (R-MRP) Annual Notice | |
| Health & Welfare | IATSE Relief Letter for Health & Welfare Participants affected by Hurricanes Harvey, Irma, or Maria | |
| Health & Welfare | HIPAA FAQs for Locals | |
| Pension | Annual Funding Notice for 2015 - Pension Fund | |
| Health & Welfare | IATSE MRP/RMRP Guidebook - 2019 | |
| Booklets/Documents | HW Plan C Benefits at a Glance - 2020 | |
| General | IRS Publication 502 - Medical and Dental Expenses for 2019 Returns | |
| General | Annuity Fund Safe Harbor Notice | |
| Annuity | Seventh Amendment - Annuity Fund Plan Document | |
| Pension | Annual Funding Notice for 2018 - Pension Fund | |
| Pension | FASB Financial Statement Disclosure for 2019 | |
| Booklets/Documents | IATSE Annuity Fund SPD - Spanish | |
| Health & Welfare | CAPP Rate Notice for Quarter Beginning April 1, 2021 |