Forms
Home | Member | Benefits | General Information | Questions
The following forms are available in
PDF format and can be printed using Adobe Reader. If you don't
have Adobe Reader, you can download it by clicking this link.
Forms Table of Contents
Enrollment Card
Update Participant
Records
Direct
Deposit Authorization
Transfer of Welfare Funds
Family Privacy
Application for Pension Benefits
Transfer
Pension Contributions
Continuation of Disability
Benefits
Application for Life and Accidental Death Benefits
Death
Benefits Federal Tax Notice
Enrollment Card
Print this form to
submit Enrollment Information.
Enrollment Card
Update Participant and
Dependent Status
This form is used to
update your family status for Health and Welfare participation.
Update Participant
Records
Direct Deposit
Authorization
As of January 1,
2004, the fund requires that all pension checks be electronically
deposited. Print and fill out this form and send it to the Fund
Office with a voided check.
Direct Deposit Authorization
Request Form
For Transfer of Welfare Funds
Print this form to
request transfer of your Welfare Account Funds.
Transfer of Welfare Funds
Family
Privacy Form
Effective April 14, 2003 - New
federal regulations, called
The Privacy Rule, require the Carpenters' District Council of Kansas
City and Vicinity Welfare Fund to follow new procedures to protect the
privacy of your personal health information maintained by the Fund.
The Privacy Rule allows the Fund to use and disclose your health
information for general claims payment and Fund administration.
One restriction imposed by the new Privacy Rule is a limitation by the Fund Office on oral communications about an individual's claims with someone other that the individual for whom the claim applies. In other words, the Fund Office may only discuss an employee's claim over the telephone with an employee, not the employee's spouse; and may only talk to the spouse about the spouse's claims; and may only talk to an adult eligible child about the child's claims. All parents or guardians will continue to have access to information regarding their minor children.
We know that you or your spouse often may call the Fund Office to check on each other's claims, or on claims of your adult children who are away at college. To continue this practice, each adult family member that is eligible for benefits must complete a Family Privacy Form. You may each authorize as few or as many people as you wish to discuss your claims with the Fund Office. Print the following form, fill it out and send it to the Fund Office. Remember, without this form, the Fund Office will give information over the telephone only to the individual for whom the claim applies, not to a spouse or parent. Please call the Fund Office if you have questions.
Family Privacy
Application for Pension Benefits
Make sure you answer all questions on this form and sign the application
personally. Return the completed application to the Fund Office with a
copy of your birth certificate. This application must be received
the month prior to the date you wish your pension to become effective.
A husband and wife pension is offered. Once the Fund Office receives this completed application with dates of birth, the survivor benefits will be calculated and an election form will be mailed to you. A copy of your spouse's birth certificate and a copy of the marriage license will be required if you choose a survivor benefit.
If you are divorced, you must submit a
copy of your divorce decree, including the settlement agreement.
Application for Pension
Benefits
Request Form for
Transfer of Pension Contributions
This form is for
Carpenters who worked out of the area who are affiliated with Local
Unions participating in the Carpenters' District Council of Kansas City
Pension Plan, otherwise known as the Home Fund.
Transfer Pension Contributions
Continuation of
Disability Benefits Form
Both the member and the Physician must
fully complete this form.
Continuation of Disability
Benefits
Application
for Life and Accidental Death Benefits
Print this form to
apply for Life and Accidental Death Benefits. Return completed form with
copies of the Death Certificate, the beneficiary's Birth Certificate and
a completed Death Benefits Federal Tax Notice
to the Fund Office.
Application for Life and
Accidental Death Benefits
Death Benefits
Federal Tax Notice
Print this form to
indicate whether you want federal taxes withheld from your distribution.
Please complete this form and attach it to your request for distribution
Death Benefits Federal Tax
Notice
If you have any questions or
you wish to request any literature, please
call:
(816) 756-3313.
Or, write to us at
Carpenter's District Council of Kansas City
& Vicinity
Pension & Health & Welfare Funds
3100 Broadway, Suite 805
Kansas City, MO 64111
Or, E-Mail us at:
kcfringebens@wilson-mcshane.com
If you are requesting a
PENSION UPDATE,
please provide your
NAME and SOCIAL
SECURITY NUMBER
in the correspondence.