Text Size: A+| A-| A   |   Text Only Site   |   Accessibility
Public Employees' Benefit Board

Forms  
Employee Enrollment
Employee Enrollment (core and optionals)
Flexible Spending Account Enrollment
Self-pay Enrollment
Retiree Enrollment
Self-pay Enrollment
Midyear Change
Midyear Change
Flexible Spending Account
Healthcare FSA Prepay Request
Qualified Reservist Distribution Request
Covering Others
Affidavit of Dependency
Affidavit of Domestic Partners
Domestic Partner for Tax Status
Domestic Partnership Termination
Life & Disability Insurance
Disability Insurance Claims Packet (pdf)
Life Insurance Claims Packet (pdf)
Medical History Statement (pdf)
Medical History Statement Online
Optional Life Insurance Portabilty (pdf)
Retiree Life Conversion Packet (pdf)
Retiree Life Insurance Application (pdf)
Retiree Life Insurance Termination (pdf)
MEDEX Travel Assist Program
Long Term Care Insurance
UNUM long term care insurance coverage
Long Term Care Continuation Form
Other Forms
Weight Watchers Participation Form
Beneficiary Designation
Transfer Premium Payment
Appeal
CDL Exam Eligibility Voucher
Flexible Spending Account Claims
VSP Reimbursement
Can't find it?
View DAS' master forms page
 
Page updated: January 11, 2010

Click here to go to the Oregon Dept. of Veterans' Affairs outreach contact form

Text Only | State Directories | Agencies A to Z | Site Map | About Oregon.gov | Oregon.gov|
File Formats | Oregon Administrative Rules | Oregon Revised Statutes | Privacy Policy | Web Site Feedback|

Get Adobe Acrobat ReaderAdobe Reader is required to view PDF files. Click the "Get Adobe Reader" image to get a free download of the reader from Adobe.