NORTH ATLANTIC STATES CARPENTERS BENEFIT FUNDS
10 BROADWAY, HAMDEN, CT 06518 | (203) 281-5511 | FAX (203) 288-3235 | (800) 922-6026

Members
Login here for access to your personal fund information

CT Employers
 Login to access the on-line contribution reporting and receipts system

RI Employers
 Login to access the on-line contribution reporting and receipts system

Contribution Forms

CT Delinquency Control Policy

Business Agents CT

Business Agents RI

NE Regional Council of Carpenters

Several documents including beneficiary designation cards, applications for retirement and withholding forms are available on line. 

Complete Forms On-Line---  Many but not all of the forms below may be completed on-line, printed and then mailed to the Funds.  To complete the forms on-line simply click on the desired form below and then click on the desired section(s) of the form you would like to complete and type in the desired information prior to printing. 

To view these forms Adobe Acrobat Reader must be installed on your computer.  If you do not currently have Adobe Acrobat, you may download a free version of the Adobe Acrobat Viewer by clicking on the link below.

Health

• Independence Administrators Subscriber Claim Form (584Kb)

• NASCBF Reciprocal Request Form (2.42Mb)

• NASCBF Reciprocal Request Form Locals 326 CT and 330 RI (2.42Mb)

• Delta Dental Benefit (1.19Mb)

• Personal Representative Form (95Kb)

• Disability Claim Form (127Kb)

• Authorization for Release of Protected Health Information (137Kb)

• Alternate Address Request (1.38Mb)

Plan Booklets

Health Plan

Pension Plan

Annuity Plan

Pension

• Pension Appeal Rights (28Kb)
• Qualified Domestic Relations Order (QDRO) (100Kb)

Network Information
Provider Directory

Annuity

• Application for Benefits (1.03 Mb)

• Application for Hardship Withdrawal (624 Kb)

• Annuity Direct Deposit Form (21Kb)

• Election for Income Tax Withholding (96 Kb)

• 2022 CT-W4P (164 Kb)

• Authorization for Payment of Health Self-Pay from Fund (8 Kb)

• Voluntary Contribution Procedures and Election Form (98 Kb)

• Qualified Domestic Relations Order (QDRO) (14.3Mb)  

• Summary Annual Report (104Kb)
• Hardship Loan Application (408Kb)
• Application for Benefits – Rhode Island Pre 1/1/18 Participant (695Kb)

Other

• Explanation of Forms of Payment (208 Kb)

• Authorization for Payment of Health Self-Pay from Fund (88 Kb)

• Request for Reciprocity of Hours or Contributions (128 Kb)

Hearing Care Program

800-648-9557