 | Authorization for ACH Debits |
| Employer Accounting of Member Compensation |
| Employer Certification of Member Enrollment |
| Employer Information Form |
| Model Pick-Up Resolution for employers with existing pick-up plans |
| Model Pick-Up Resolution for employers who do not currently participate in a pick-up plan |
| New Member Information Form |
| Members Medical Questionnaire and Physicians Certification |
| Pre-Employment Physical Requirements |
| Work History Report |
| Employer Payment Remittance |
| Statement Concerning Your Employment in a Job Not Covered by Social Security |
