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Important News - Editable Forms are here!

In order to serve you better, HART's forms are now editable. With an editable form, you can enter the required information using your computer or other device* instead of writing your responses by hand. The completed form can then be printed, signed and submitted to HART for processing.

By submitting forms that were filled in using your computer or other device, you help to reduce the errors and confusion that can sometimes occur with hand-written responses. This allows us process your forms more quickly and efficiently, and to provide better service for you!

Editable Form This icon in the list below indicates the form is editable.

* Note: To use an editable form, you may need to install the latest version of Adobe® Reader® software on your device. To download this free software, follow the link at the bottom of this page.

Form Name & Number Description
Editable Form Enrollment Form #110 Enrollment Form #110
Editable Form Change of Address Form #120 Change of Address Form #120
Editable Form Age 55 or Older Provision Form #130 Request For Partial Payments Under the “Age 55 Or Older Provision” Form #130
Editable Form Change of Beneficiary Form #140 Change of Beneficiary Form #140
Editable Form Request for Benefit Payment Form Package #150 Request for Benefit Payment Form package #150 for terminated or retired participants. Includes Form 150, Options Available upon Termination or Retirement document and the Special Tax Notice document.
Editable Form Notice Of Changes Form #160 Notice Of Changes Form #160
Editable Form Voluntary Account Withdrawal Request Form Package #170 Voluntary In-service Withdrawal Form Package #170 - Includes The Voluntary In-service Withdrawal Form and instructions, plus the Special Tax Notice document. This is for active employees who contribute voluntarily.
Editable Form Rollovers Into HART Form #180 Rollovers Form #180 - Includes instructions for rolling prior plan money into this Plan and the address for mailing the rollover check.
Editable Form Rollovers Into HART Form #180A Rollovers Form #180A - Includes instructions for rolling prior plan money into this Plan and the address for mailing the rollover check.
Editable Form Request To Withdraw A Rollover Account Form #190 Request To Withdraw A Rollover Account Form #190
Editable Form Loan Repayment Form #279 Loan Repayment Form #279 - Includes instructions for paying off a loan and the address for mailing the check.
Editable Form Unknown Address Form #300 Unknown Address Form #300 - Used to submit information on employees who cannot be located.
Editable Form HART Access Authorization Form HART Access Authorization Form
Loan Provisions Loan Provisions
Editable Form Retiree Life Insurance Enrollment Form Retiree Life Insurance Enrollment Form
Rate Table For Retiree - Minnesota Life Rate Table For Retiree - Minnesota Life

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