Find and download different forms relating to Local 94 and its affiliated Benefit Funds.
Local 94 Forms
Annuity Fund Forms
- For all Annuity Fund Forms, such as a distribution request, loan application or beneficiary form, please visit the mylife.jhrps.com. website.
Health and Benefit Trust Fund Forms
- Empire Claim Form (PDF)
- CVS/Caremark Mail Service Order Form
- CVS/Caremark Prescription Reimbursement Claim Form
- Sele-Dent Claim Form (PDF)
- Coordination of Benefits Form (PDF)
- Beneficiary Designation Form (PDF)
- Commercial Loss of Time Claim Form (PDF)
- School Loss of Time Claim Form (PDF)
- Authorization to Release PHI Form (PDF)
- Commercial In-House Claim Form (PDF)
- School Retiree Medicare Related Premium Reimbursement Form
- School In-House Claim Form (PDF)
- For all Pension forms, such as beneficiary, direct deposit, and retirement application forms please visit the Central Pension Fund website.
Scholarship Fund Forms
Sick Fund Forms
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Why do I owe dues if I am on Dues Checkoff?
If you signed up for dues check-off, your monthly dues should be automatically withdrawn from your paycheck and sent by your employer to Local 94. However, sometimes an employer may not withhold your dues or your employer may withhold an incorrect amount. If this happens, you as the member are responsible for any unpaid dues, unless you can provide a copy of your paystub showing that your dues were withheld by your employer. If that happens, the Union will pursue the matter with your employer directly, and you are not responsible for paying any unpaid dues.