ScottsdaleAZ.Gov

     
      Address Change Form

    ASRS Change of Address Form

    PSPRS Address Change Form
 

ASRS Forms
     ASRS Presidential Callup Form
 

     ASRS Return to Work Form
 

     ASRS Beneficiary Change Form
 
     ASRS Change of Address Form
 

Dental Claim Forms
  
    Assurant Dental (formerly Fortis)
       
    Delta Dental Claim Form
      

DEPENDENT VERIFICATION FORM
 

Domestic Partner Affidavit
 

Emergency Contact Change Form
 

Enrollment Forms
 
     Benefits Enrollment or Change Form 

Flexible Spending Account Forms
       
    Claim Form 

    Direct Deposit Request Form 

    FSA Debit Card Application
 

Health Claim Forms
     Aetna 
            
    HSA Change Form
 

HIPAA Forms
     HIPAA Privacy Notice
       
     Use/Disclosure Authorization
       
     Revocation of Authorization for the Use & Disclosure of PHI
       
     Request for Confidential Transmission of PHI
       
     Request for Restrictions on Use & Disclosure of PHI
       
     Request to Inspect & Copy PHI
       
     Request to Amend PHI
       
     Request for Accounting of Plan's Disclosures of PHI
       
     Privacy Complaint Form
      

ICMA Forms
     ICMA Change Form
 
     ICMA 457 Beneficiary Change Form
             
     ICMA Roth IRA Application Form
       
     ICMA Roth Change Form
 
     ICMA 457 Rollover Packet & Forms
    

Leave Forms

Leave Of Absence Notification
 
Return to Work Evaluation
           

Life Insurance
     Beneficiary Change Form for Life and Vol Life    
 
     Voluntary Life Insurance Change Form
       

Name Change
 

Paycheck Direct Deposit Enrollment
         

Payroll Tax Forms
     W4 - Tax Form
       
     Arizona A-4 Form 
        

Prescriptions - Mail Order Forms
     Aetna
 

Public Safety Personnel Retirement System Forms
(www.psprs.com)
 
PSPRS Beneficiary Change Form
 

Surepay Retiree/COBRA Automatic Payment Enrollment Form (PDF/ 107KB / 1 pg)