Employee Forms CCOERA Retirement Flex Comp Medical / Dental / Vision Life Insurance Health Club Memberships Payroll Workers' Compensation Family & Medical Leave Sick Leave Transfer Performance Evaluation Forms

High Profile Photo Courtesy of Bev Alexander

CCOERA Retirement

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Click on any of the following to retrieve the form.

401(a) 3% Mandatory Contribution Plan

• 401(a) Enrollment Form (Must be obtained at the Personnel Office)
• 401(a) Salary Deferral Agreement - to add or change voluntary contributions after-tax up to 10% of gross salary
• 401(a) Beneficiary Change Form -Beneficiary can also be changed online @ ccoera.org
• Personal Information Change Request Form
• Electronic Funds Transfer Form
• Incoming Transfer/Direct Rollover Form
• Distribution/Direct Rollover Request Form

457 Optional Contribution Plan - Before Tax (County will match up to an additional 2% contribution)

• 457 Enrollment Form
• 457 Salary Deferral Change Request Form - to add or change before-tax optional contributions
• 457 Beneficiary Change Form - Beneficiary can also be changed online @ ccoera.org
• Personal Information Change Request Form
• Electronic Funds Transfer Form
• Incoming Transfer/Direct Rollover Form
• Catch-Up Form
• Distribution/Direct Rollover Request Form
  

PayFlex Flex Comp

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Click on any of the following to retrieve the form.

• Flexible Benefits Enrollment Form
• Request for Reimbursement Form
• Request for Reimbursement Grace Period Form
• Auto Submission Authorization Form
• How Flex Accounts Work
• Mid-Year Flex Election Change Form
• Eligible Expenses in an Flexible Spending Account
• Over-the-Counter Drug Guidelines
• Flexible Benefits Planning Worksheet
• Who is an Eligible Dependent
• HIPAA Notice of Privacy Practices
  

Medical / Dental / Vision

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Click on any of the following to retrieve the form.

• Medical Insurance Enrollment Form
• Medical Insurance Change Form
• Dental Insurance Enrollment Form
• Dental Insurance Change Form
• Vision Insurance Enrollment Form
• Vision Insurance Change Form
• Gunnison County Employee Benefit Plans Privacy Notice
  

Life Insurance

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Health Club Memberships

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Payroll

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Workers' Compensation

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Family & Medical Leave

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Sick Leave Transfer

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Performance Evaluation Forms

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• Employee Input Form
• Supervisor Evaluation Form

Office Hours

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8:00 a.m. - 12:00; 1:00 – 5:00 p.m.
Monday through Friday (except weekends & holidays)

Contact Information

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Gunnison County Personnel Attn: Debbie Moore 200 East Virginia Gunnison, CO  81230

Phone:  (970) 641-7623 (Voicemail is available 24 hours per day)  Fax:  (970) 641-7618 Email Debbie