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Useful Forms for Members

Complete your 2024 Eligibility Form Electronically (Click Here)

2024 Continued Eligibility Verification Form

Spouse Declaration Form

Dependent Declaration Form

Initial Enrollment Form 

Enrollment Addition Form (New Spouse/Child) 

HRA Claim Form 

Fitness Membership/Health Class RX Form 

Death Benefit Beneficiary Form 

Local Pension Beneficiary Form 

PHI Authorization Form (Protected Health Information) 

Injury Detail Form 

Short-Term Disability Form 

Dental & HRA Opt Out Forms

Fund Office

Plumbers & Steamfitters Local Union 33 Fund Office
2501 Bell Avenue, Des Moines, IA 50321
Phone: 515-243-3246
Fax: 515-244-6606
[email protected]

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