Authorized Representative Certification [PDF] Claim Form [PDF] Direct Deposit Enrollment Form [PDF] HRA Final Claims Verification Form [PDF] HRA Repayment of Claim Form [PDF] HRA Waiver of Future Reimbursement Election form [PDF] HRA- HIPAA Authorization Form [PDF] Surviving Spouse Certification Form [PDF] Systematic Premium Reimbursement Form [PDF] Transfer of Enrollment [PDF] Transfer of Enrollment for Divorce [PDF] VL 40590 HRA Benefits Card Supporting Documents [PDF] VL 40591 HRA Benefits Card Supporting Documents - OBB Prefil [PDF]