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December 27, 2016 | Print | Site Map | Help
 

Pension Plan

 
Pension Application
  • Application for Benefits (File size - 24K)
    Complete this form and mail to the Trust Fund Office in order to begin the application for benefits process.

    This fill-in PDF form uses features best supported by Adobe Acrobat Reader. You may download Acrobat Reader for free from Adobe.
  • Alternate Payee Application for Benefits (File size - 26K)
    Complete this form and mail to the Trust Fund Office in order to begin the application for benefits process.
Death Benefit Application
Tax Forms
  • IRS Form W-4P (File size - 134 K)
    Withholding Certificate for Pension or Annuity Payments. Required to complete your election for federal tax withholding.
  • State of California Form DE 4P (File size - 414 K)
    Withholding Certificate for Pension or Annuity Payments. Required to complete your election for state tax withholding.
Other Forms
  • Direct Deposit Form (File size - 55K)
    If you would like to receive your benefit payments in a safe, fast and confidential way, complete this direct deposit payment direction form.
  • Sample QDRO Form (File size - 33K)
    If you are separating or divorcing, you and your attorney will want to review this form. This sample will help your attorney create a QDRO acceptable to the plan.
  • Sample QDRO Form - Retirees (File size - 20K)
    If you are separating or divorcing, you and your attorney will want to review this form. This sample will help your attorney create a QDRO acceptable to the plan
  • Change of Address Form (File size - 24K)
    To ensure that you receive important benefit information in the mail, use this form to notify the Fund Office if you change your address.
  • Beneficiary Designation (File size - 18K)
    Submit this form to designate a new beneficiary or change an existing beneficiary.
  • Social Security Administration Authorization Form (File size - 174K)
    This form allows the Fund Office to obtain work history and earnings information on your behalf.
Annual Funding Notice
Summary Annual Reports
  • SAR (File size - 95 K)
    San Joaquin County Painters Pension Trust Fund for the 10 month period ending May 31, 2008
  • SAR (File size - 300 K)
    For the year ending December 31, 2007.
Notices of Endangered or Critical Status
Worker, Retiree, and Employer Recovery Notices Act
  • There are no WRERA notices at this time.

Contact Plan Administrator

Telephone NumberPhone:
(866) 894-3705

ContactEmail:
paintersinfo@hsba.com

Click for MapVisit Us
Health Services & Benefit Administrators, Inc. (HS&BA)
4160 Dublin Boulevard, Suite 400
Dublin, CA 94568-7756

Contact Website Technical Support
regarding questions related to the use of this web site.

Toll Free(866) 367-8265

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