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  Certified Mail Revocation of Payroll Deducted BLE Dues Form (revised 1-2006) 
Description: Form used by BLET to stop dues withdrawal by employees leaving the BLET to rejoin (or initially join) the UTU.  This form should be sent certified to the BLET Treasurer and CSXT Director Payroll Production Pam Overbay, as indicated on the form. 
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Added on: 11-Jun-2007 Downloads: 217
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  CHANGE IN FAMILY STATUS FORM FOR HEALTH AND WELFARE INSURANCE 
Description: Form used to notify an employee's healthcare provider of a change in his family status (no of dependents, etc.)
Version: Filesize: 0 bytes
Added on: 11-Jun-2007 Downloads: 200
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  CSX MD3 Form for Medical Return To Work 
Description: CSX MD3 form needed by T&E employees to return to work after an injury/illness leave of more than seven (7) days, but less than one year.
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Added on: 11-Jun-2007 Downloads: 271
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  Flowback Bid Form 
Description:
Flowback Bid Form - can be submitted quarterly to flow from engine to train service, or train to engine service, seniority permitting.  Bids may be submitted the first seven days of each quarter (January, April, July and October) and will accepted until 2330 hours on the final day.  During the intervening seven days the successful applicant(s) will be notified and the bid will become effective at 0001 hours on 15th day of the month.


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Added on: 25-Jun-2007 Downloads: 302
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  HIPAA Release Form 
Description: Form used to release sensitive medical information under the Health Insurance Portability and Accountability Act (HIPAA). 
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Added on: 11-Jun-2007 Downloads: 207
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  Proof Of Disability Form 
Description: Proof Of Disability Form (updated 2010)
Version: Filesize: 0 bytes
Added on: 23-Jan-2006 Downloads: 447
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  Provident Disability Program Booklet 
Description: Current Provident Supplemental Disability Insurance booklet pursuant to Rule 100, Section 15 of the B&O Schedule Agreement.  Trainmen with 6 months of continuous active service under the B&O Conductors and Trainmen Agreement (or B&OCT Agreement) are eligible for this Supplemental Disability insurance in the event they are sick or disabled and collecting RRB Sickness Benefits.  Plan Number M-948-ASO.
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Added on: 13-Mar-2009 Downloads: 128
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  Provident Notice of Disability Forms 
Description: Provident Insurance Company forms for filing for Supplemental Sickness Benefits under Rule 100, Section 15 of the B&O Schedule Agreement.
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Added on: 11-Jun-2007 Downloads: 321
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  Railroad Retirement Board Sickness Benefits 
Description: Railroad Retirement Board Sickness Benefits booklet and application form.  For more information, visit the Railroad Retirement Board website in the "Links", then "Handy Government Links" section of this website.
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Added on: 11-Jun-2007 Downloads: 197
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  Railroad Retirement Board Unemployment Benefits 
Description: Railroad Retirement Board Unemployment Benefits booklet and application form.  For more information, visit the Railroad Retirement Board website in the "Links", then "Handy Government Links" section of this website.
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Added on: 11-Jun-2007 Downloads: 253
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