Forms

To see and print any of the forms below simply click on the form name. The form may take differing amounts of time to populate depending upon your type of Internet connection and your computer’s processing power. Print and prepare the selected form according to its instructions and mail to the Little Falls offices to the attention of the appropriate department.

IMPORTANT: New form required with Health Care Coverage Enrollment

The NOTICE AND ACKNOWLEDGEMENT OF TERMS OF COVERAGE UNDER THE WELFARE FUND must be prepared, signed, dated and submitted with the Health Care Coverage Enrollment form. Simply click on this form to download and print. It is listed just beneath the Health Care Enrollment Form (these two forms must be submitted together). Health care enrollment and coverage cannot be provided without the accompanying Acknowledgement form.

Downloads
Authorization for Representation-English
Authorization for Representation-Spanish
Dental Claim Form (May also be used for Pre-Authorizations)
Mandatory Second Opinion-Page 1
Mandatory Second Opinion Page-2
Prescription Claim Form
Health Care Coverage Enrollment Form
Notice and Acknowledgement of Terms of Coverage Under the Welfare Fund