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This form should be used if you would like another person or entity other than yourself to receive your protected health information.
This form should be used to notify EIT of your new address. You can also register for an EIT Online Account to make future address changes.
Federal Law now requires that health plans report Social Security Numbers (SSNs) for covered dependents. Please utilize this form to provide SSNs for all dependents.
Direct Deposit is now mandatory for all payments including Pension, Supplemental Unemployment and Disability.
Disability application instructions and forms to apply for Disability Benefits.
(Disability Benefits do not apply to Participants of the Participatory Plan or who are currently covered under COBRA)
This is a form to fill out and mail to us if you would like to designate a beneficiary or update beneficiary information.
Use the forms below for Pension requests.
Request for Disabled Dependent Coverage Form.
As of 3/29/2020, EIT is no longer accepting paper/email/fax applications or certifications. You must use the online forms below.
Effective November 1, 2015, if you are injured at work, you must file a completed Workers’ Compensation Disability Statement within 90 days of the later of either the last day
you worked contributed hours or the date of your injury. Claims filed after 90 days will not be accepted and no Disability Hours will be credited to maintain your health insurance.
- IL W-4 (Illinois Employee Withholding)
- IL W-5-NR (Illinois Nonresidence Statement)
- IRS W-4 (Federal Employee Withholding)
- IRS W-4P (Federal Pension Withholding)
- IRS W-4S (Federal Sick Pay Withholding)
- IRS W-9 (Request for Taxpayer Identification)
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