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
Need to Find a Doctor, Dentist or Vision Specialist?
How much are the dues?
Effective January 1, 2017, the maximum monthly dues are $87.55.
The predominant dues structure is as follows:
- 40 hour contracted work weeks are calculated by multiplying the hourly rate x 2.50
- 35 hour contracted work week hourly rate x $2.20
- 37 1/2 hour contracted work week hourly rate x $2.36
Please call the Union Office at (212) 331-1800 with any questions. You can also visit the Contact Us page for more information.