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December 27, 2016 | Print | Site Map | Help
 

Welcome

Pension Plan

 
Pension Application
  • Pension Application (File size - 156 K)
    Use this form to submit your application to the Plan Adminstrator

    This fill-in PDF form uses features best supported by Adobe Acrobat Reader. You may download Acrobat Reader for free from Adobe.
Tax Forms
  • IRS Form W-4P (File size - 135 K)
    Withholding Certificate for Pension or Annuity Payments. Required to complete your election for federal tax withholding.
  • State of California Form DE 4P (File size - 414 K)
    Withholding Certificate for Pension or Annuity Payments. Required to complete your election for state tax withholding.
Other Forms
Annual Notices
Notices of Endangered or Critical Status
Summary Annual Reports
  • There are no Summary Annual Reports at this time.
Other Notices
  • There are no Other Notices at this time.

 

Contact Plan Administrator
regarding questions about your benefits

Telephone NumberPhone
(800) 782-0010

Contact FormEmail:
resilientinfo@hsba.com

Click for MapVisit Us
Health Services & Benefit Administrators, Inc. (HS&BA)
4160 Dublin Boulevard, Suite 400
Dublin, CA 94568-7756

Contact Website Technical Support
regarding questions related to the use of this web site.

Toll Free(866) 367-8265