Forms for Employees
Documents are in PDF unless specified otherwise.
- Direct Deposit Form
- Expense Reimbursement - 2018 Calendar Year
- Expense Reimbursement - 2019 Calendar Year
- HSA (Health Savings Account) Payroll Deduction Authorization
- Incident Report Form
- Name and/or Address Change for Employees
- Member Forms (Enrollment, Mid-Year Change, Beneficiary Designation, etc.)
- Reference Authorization Form
- Carruth Compliance Consulting (CCC) is the third party administrator and primary point of contact for Lane ESD's 403(b) and 457(b) TSA plans. Go to CCC's website for current Lane ESD TSA information.
- 2019 TSA Eligibility and Limits Announcement/Guide
- Effective January 1, 2019 both an Oregon W-4 form and Federal W-4 form must be completed when making any changes (even if the same number of allowances will apply to both).
- Worker's Compensation Claim Form 801 and Instructions
For more information contact:
Human Resources at 541-461-8202 or email@example.com