Human Resources

Forms

• Direct Deposit Form
• Expense Reimbursement - 2019 Calendar Year
• Expense Reimbursement - 2020 Calendar Year
• FMLA/OFLA
  • FMLA/OFLA Application
• FSA/HRA
  • Chard-Snyder FSA (Healthcare and Dependent Day Care) 2019-20 Enrollment Form
  • Chard-Snyder FSA (Healthcare and Dependent Day Care) Claim Reimbursement Form
  • Chard-Snyder HRA Claim Reimbursement Form
• HSA (Health Savings Account) Payroll Deduction Authorization
• Special Education only: Incident Report online formOpens a new window/tab
• Non-SPED employees: Incident Report Form
• Name and/or Address Change for Employees
• OEBB
  • Member FormsOpens a new window/tab (Enrollment, Mid-Year Change, Beneficiary Designation, etc.)
• Reference Authorization Form
• Sick Leave Bank Enrollment Form
• TSA
  • Tax Sheltered Annuity (TSA) Enrollment 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 informationOpens a new window/tab.
  • 2019 TSA Eligibility and Limits Announcement/Guide
  • 2020 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).
  • W-4 Form - Federal
  • W-4 Form - Oregon
• Worker's Compensation Claim Form 801 and Instructions