Amsterdam Teachers' Association 1 Reid Street Amsterdam, NY 12010
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Find your needed forms here! 

For Employees
The district provides employees and retirees with a brief summary of all health insurance benefits along with plan rate sheets. These documents are available for download as a PDF. Hard copies of these documents are available in the district office. 
Please remember that MVP operates on a calendar year (January 1 to December 31), while PPOB and CDPHP operate on a fiscal year (July 1 to June 30). Applications must be submitted prior to open enrollment. 
If you have any questions or concerns, please contact Sarah Jones at (518) 843-3180 ext. 7403 or [email protected]

For Retirees
Retired employees who have questions about health insurance or are looking for a specific document can contact Sarah Jones at [email protected] or 518-843-3180 x. 7403.
2022-2023 Payroll
2022 Federal Withholding Certificate
File Size: 1696 kb
File Type: pdf
Download File

2022 New York State Withholding Certificate
File Size: 4426 kb
File Type: pdf
Download File

PR-06 Direct Deposit
File Size: 234 kb
File Type: pdf
Download File

403b Information
Benetech Starting Guide
File Size: 44 kb
File Type: docx
Download File

Benetech 403b Provider List
File Size: 22 kb
File Type: docx
Download File

Benetech Salary Reduction Agreement
File Size: 515 kb
File Type: pdf
Download File

Universal Availability Mailer 2022
File Size: 35 kb
File Type: doc
Download File

Health Insurance Forms 
Declination Form
File Size: 48 kb
File Type: docx
Download File

Health Reimbursement Forms 
BT HRA Expense Recovery Form Revised- March 2022
File Size: 581 kb
File Type: pdf
Download File

Flexible Spending 2023
2022 Participant Direct Deposit Authorization Form
File Size: 83 kb
File Type: pdf
Download File

2022 FSA Eligible
File Size: 164 kb
File Type: pdf
Download File

2022 5 New Eligible Expenses Cares Act
File Size: 276 kb
File Type: pdf
Download File

App Scanner
File Size: 424 kb
File Type: pdf
Download File

Benetech Mobile App Mailer
File Size: 313 kb
File Type: pdf
Download File


BT FSA Medical Expense Claim Form Revised- March 2022
File Size: 581 kb
File Type: pdf
Download File

Direct Deposit Form
File Size: 45 kb
File Type: pdf
Download File

FSA HRA Eligible List
File Size: 100 kb
File Type: pdf
Download File

HRA Enrollment Form
File Size: 14 kb
File Type: pdf
Download File

HRA Mobile App Overview
File Size: 314 kb
File Type: pdf
Download File

APPR forms
Final Pre-Observation Form
File Size: 36 kb
File Type: docx
Download File

Final Post Observation Form
File Size: 39 kb
File Type: docx
Download File

Class Profile Form
File Size: 29 kb
File Type: docx
Download File

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  • Home
  • ATA Leadership
  • Capital District Regional Office
  • Photos
  • Calendar
  • NYSUT BENEFITS
  • Forms
  • About Us