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Benefits Forms

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All forms are available for download in PDF format. In order to view PDF documents you need Adobe Acrobat Reader (available free from Adobe Systems). Follow the instructions for download and installation, and return to this page. These forms have been optimized for use with the latest version of Adobe Acrobat Reader. Previous versions may cause the documents to display improperly. If you are using version 4 or older, please download the update.   Please print, fill out, and return completed forms to: The Benefits Division at HRD-133 or Fax: (650) 599-1573 (*Mail to the County Controller's Office at PONY CTL-135) Core Programs New Enrollment Open Enrollment Change Employee Benefits Affidavit for Young Adult Dependent Affidavit of Domestic Partnership Blue Shield Subscriber Statement of Claim Form Short Term Disability Claim Forms (your payroll clerk must submit ALL 4 FORMS!) Expanded Disability Income Insurance Enrollment Form Work/Life Programs Care$hares Enrollment Form (now part of FSA) Care$hares Reimbursement Care$hares Dependent Care Reoccurring Reimbursement VTO Application Telecommuting Application Catastophic Leave Application Leave of Absence Donation for Catastrophic Leave On-site Child Care Registration FSA 2008 Guide for San Mateo County  (contains Enrollment Form and Expense Estimator Worksheet) FSA 2008 Enrollment Form  FSA 2008 Expense Estimator Worksheet FSA 2008 Claim (Reimbursement) Form FSA Smart Flex Form FSA 2008 Direct Deposit Form FSA OTC Medicines and Drugs Substantiation Guidelines FSA Detailed Eligible and Ineligible Guidelines FSA 2008 Fact Sheet FSA Powerpoint Presentation   Health & Fitness County Claim Reimbursement Guidelines Massage Therapy Registration Deferred Compensation SMC Investment Policy    Deferred Compensation Formal Plan    Hardship Withdrawal Request Packet Rollover Checklist For more information on Deferred Compensation Packets, please contact  Benefits. Hartford Life Web site              To access your Hartford deferred compensation account online and utilize Morningstar ClearFuture®, or to experience an interactive demo of HartfordOnline and Morningstar ClearFuture®, visit us at: https://retire.hartfordlife.com. To access the demo, click on HartfordOnline Access and use the following User ID and PIN: User ID: demoplan PIN: password Select Morningstar, then select "take a tour". Forms   Nationwide web site Forms