Program Details
Eligibility
Effective Date of Coverage
Premiums/Rates
Technical Letters
Administrative Guide
Carrier Materials
FAQs
Forms
Carrier Contact
Employee Category
Physicians
(Unit 1)
CSUEU
(Units 2, 5, 7, 9)
Faculty
(Unit 3)
Academic Support
(Unit 4)
Skilled Crafts
(Unit 6)
Public Safety
(Unit 8)
CMA Operating Engineers
(Unit 10)
Teaching Associates
(Unit 11)
Management
Personnel Plan
(M80)

Forms — Dependent Care Reimbursement Account Plan

(NOTE: On-line documents are in Portable Document Format (PDF) and
require Adobe Acrobat Reader to view, unless otherwise noted.)
 
  • Enrollment Authorization Form
    		•
     
  • DCRA/HCRA Combined Claim Form

    		•
     
  • HIPAA Authorization Form
    		•
     
  • HIPAA Privacy Notice

    		•
    Content Contact:
    Human Resources Management
    (562) 951-4411
    		 Technical Contact:
    webmaster@calstate.edu

    Last Updated: October 4, 2007

    HR Home | HR Admin | Bargaining Agreements | Benefits | Class Standards 
    Coded Memos | Payroll | Policies | Salary Programs | Salary Schedule