| Form | Revision Date | Download |
|---|---|---|
| 2023-24 Benefit Guide | 2023 | Download |
| Annual Notices with COBRA | 2023 | Download |
| Direct Deposit Form | 02/18/22 | Download |
| Employment Application | 02/18/22 | Download |
| Employee Performance Evaluation | 01/06/23 | Download |
| GOV.11.B Request for Reasonable Accommodation Form-1 | 9/1/15 | Download |
| HS.5 Fire Drill Log | Download | |
| OSHA Injury Report | Download | |
| Salary Reduction Agreement | 2023 | Download |
| W-4 Federal | 2024 | Download |
| W-4 Maine | 2024 | Download |
| Form | Revision Date | Download |
|---|---|---|
| ACH Authorization Form | 2022 | Download |
| Benefit Plan Design | 2023 | Download |
| CORNBEHHRA Action By Board of Directors | 2023 | Download |
| Enrollment & Termination Form | 2022 | Download |
| Health Reimbursement Process | Download | |
| HRA Summary and Benefits Coverage | 2023 | Download |
| SBC Uniform Glossary | 2022 | Download |
| Form | Revision Date | Download |
|---|---|---|
| Group Enrollment Form | 2023 | Download |
| ME Health Care Coverage Waiver Form | 2023 | Download |
| Summary of Benefit and Coverage | 2023 | Download |
| Form | Revision Date | Download |
|---|---|---|
| Dental Highlight Sheet | 07/01/2023 | Download |
| Dental Plan Description | 7/1/17 | Download |
| Enrollment Change Form | 2019 | Download |
| Non-discrimination Notice | 07/23/23 | Download |
| Privacy Notice | 07/24/23 | Download |
| Form | Revision Date | Download |
|---|---|---|
| Benefits Enrollment Form | 2019 | Download |
| Claim Submission Process | Download | |
| Client Information Sheet | Download | |
| Short-term Disability Claim Form | 2018 | Download |
| Form | Revision Date | Download |
|---|---|---|
| Employee of the Month Program | Download | |
| Employee of the Month Nomination Form | Download | |
| Employee of the Month Nomination Form (Printable) | Download |
| Form | Revision Date | Download |
|---|---|---|
| Electronic American Funds Simple IRA Application | 2022-2023 | Download |
| Simple IRA Salary Deferral Election | Download |
| Form | Revision Date | Download |
|---|---|---|
| CBH Premium Conversion Plan Summary Plan Description | 2023 | Download |
| CBH Wrap Summary Plan Description | 2023 | Download |
| Employee Acknowledgement of Receipt of Summary Plan Description | 2023 | Download |