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December 27, 2016 | Print | Site Map | Help
 

Annuity Plan

 
Application Forms
  • Application for Benefits (File size - 64 K)
    Complete this form and mail to the Trust Fund Office in order to begin the application for benefits process.
  • Alternate Payee Application for Benefits (File size - 73 K)
    Complete this form and mail to the Trust Fund Office in order to begin the application for benefits process.
Death Benefit Application Form
Tax Forms
Other Forms
  • 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.
  • Sample QDRO Form (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.
  • Beneficiary Designation (File size - 18K)
    Submit this form to designate a new beneficiary or change an existing beneficiary.
  • Direct Deposit Form (File size - 18K)
    If you would like to receive your benefit payments in a safe, fast and confidential way, complete this direct deposit payment direction form.
Funding Notices and SARs
  • SAR (File size - ? K)
    For the year ending December 31, 2015
  • SAR (File size - 11K)
    For the year ending December 31, 2011
  • SAR (File size - 27K)
    For the year ending December 31, 2010
  • SAR (File size - 42K)
    For the year ending December 31, 2009
  • SAR (File size - 25K)
    For the year ending December 31, 2008
  • SAR (File size - 265K)
    For the year ending December 31, 2007
Other Reports
  • There are no other reports 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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