Health Benefit Forms

All forms below are listed in Adobe .pdf format. If you need futher information or an alternate format, contact Judy Nosal at NosalJ@so.ct.edu.

Sick Leave Bank Forms

Management Confidential Sick Leave Bank Grant Application Form

SUOAF Sick Leave Bank Grant Application Form

Leave Request Forms

Family and Medical Leave Act Leave Request Form

Medical Certificates

Employee Medical Certificate P-33A

Caregiver Medical Certificate P-33B

Other Resources

Employee Assistance Program (The Lexington Group)

Family Medical Leave Act (FMLA)

Health Care Options Planner 2007 (State of CT Comptroller)

Frequently asked Questions Regarding State Employee Benefits for Same Sex Partners