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This Employee Services page is sponsored by the Human Resources department. We hope it provides the information you need, but if it doesn't, contact us at 855-6500.

Employee Change Forms

It is very important that Human Resources has accurate information. If you have changed addresses, please fill out the change of address form and send it to HR as soon as possible. If your emergency contact information needs to be updated be sure to complete and return the emergency contact information form.

Change of Address Form 
Emergency Contact Information

If you would like to change your Federal Tax Withholding amount or NYS Tax withholding amount please complete the appropriate form and submit those to HR.

Federal withholding Allowance Form
NYS Withholding Allowance Form
Improve your health and fitness with this free online resource, visit www.bcbswny.com.

Blue Cross Blue Shield Claim
Blue Cross Blue Shield Enrollment
For employees enrolled in the High Deductible Plan, the Health Reimbursement Account annual credit is $1,500 single and $3,000 family.

These are the most commonly used forms:
BCI HRA Debit Authorization Form
Health Now Claim Form
HRA Enrollment
During the annual open enrollment period you can utilize the following forms to enroll in dental and eye coverage:
GHI Dental enrollment
EyeMed Enrollment Form

To find a participating dental provider follow these instructions:
GHI/Emblem Health Participating Dentist Instructions

To locate a participating eye care provider (choose the Select network):
https://www.eyemedvisioncare.com/locator/locator.emvc?execution=e1s1

Complete and submit the following claim form for dental services:
Dental Claim Form
Please contact Child & Family Services for employee assistance at:

Buffalo/Erie County:  (716) 681-4300
Outside of Erie County:  (800) 888-4162

Online at:  EAP.cfsbny.org
EAP Free Consultation Services
EAP Summary of Benefits