Welcome to the Welfare Fund Forms Section

With possible disruptions with the US Postal Services and limited access to the Fund Office. All applications and related documents should bee sent by e-Mail or Text to info@ualocal1funds.org or by fax to 718-641-8155.

Weekly Unemployment Benefit Form - NEW

Statements stating that your unemployment claim is being reviewed/processed are insufficient when applying for this benefit. You must submit proof for each week that you have collected/received State Unemployment Benefits. This benefit is paid by the Fund monthly, we encourage you to combine multiple weeks in a single claim. Also, the requirement to submit the Weekly Unemployment Benefit Form in person and Section D or Local 1's Certification has been temporarily suspended.

HRA Claim Form

HRA Payment Authorization Form

Change of Address Form

Extension of Eligibility Form

Beneficiary Designation Form

Special Enrollment Form (Adult Child to Age 26)

Benefit Enrollment Form

Universal Enrollment Form

PHI Authorization Form

PHI Cancellation Form



Certification of Medical Necessity Form

Qualified Relative Certification Form

Dental Claim Form Out-of-Network

Vision Claim Form Out-of-Network

Hearing Aid Claim Form

Medicare Claim Form

Notarized Affidavit of Current Marriage

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