Important Forms and Documents

General Forms and Resources

Change of Address Form
Participants and Beneficiaries Form

Health and Welfare Forms and Resources

August 2022 HIPAA Privacy Notice
Authorization to Disclose to Attorneys and Others
Bridge Plan Enrollment Form, effective March 1, 2024
Caremark Mail Service Order Form
CVS / Caremark Prescription Reimbursement Claim Form
Disability Credit Application
EyeMed Member FAQ
EyeMed Out-of-Network Vision Services Claim Form
Fitness Reimbursement Form
Hearing Plan Information
HIPAA Authorization Form
IUOE 4 Medical Subscriber Reimbursement Form
Loss of Time Form
Subrogation Form
W-4 Request for Federal Tax Withholding from Sick Pay
Weight-Loss Reimbursement Form

Pension Forms and Resources

2024 Form W-4P Pension and Annuity
Massachusetts Withholding Exemption Certificate for Pension and Annuity
IUOE L4 Pension Fund Election of Tax Withholding Form

Annuity and Savings Forms and Resources

401(k) Election Form

Fidelity NetBenefits

Employer Forms and Resources

Employer Letter re: Contributions Processing Updates, effective 1/1/2023
ESS Instructions
4E Field Engineers Wage Schedule, effective November 1, 2024
Employer Adjustments Form
401(k) Election Form
Letter: MA Rates, MA Rate Sheet & Sample Calculations, effective December 1, 2024
Letter: NH/Maine Rates & Maine/NH Building & Highway Rate Sheet & Sample Calculations, effective December 1, 2024

Frequently Asked Questions

I’d like to change my address. Can I give you my new address over the phone?

No, we require all members to provide us any address (or name) changes in writing – signed and dated by the member. Please submit changes via the form on the website, or simply write us a note including name, SSN, new address and old address, sign and date the document.

Address changes can be mailed to PO Box 680, Medway, MA 02053 or sent via fax: 1-508-533-1425. Members also have the ability to change their address via the Member Self Service Module (“MSS”) available on the Funds website: Local4Funds.org. Members must change their addresses with the Union Hall and Apprentice & Training Center separately.