Employee and Retiree Benefit Information

401(k) Contribution Change Form

Use this form to change how much you contribute to your Empower 401(k) plan.

 457 Deferral Change Form

Use this form to change how much you contribute to your Empower 457 plan.

Status Change Form

Use this form to update your personal or dependent information for benefits (such as birth, marriage, or divorce). You can also use it to update your address, phone number, or emergency contacts. Return the completed form to HR.

Direct Deposit Form

Use this form to start, change, or stop direct deposit for your paycheck. Return the completed form to Payroll.

Request to Retire Form

Use this form to prepare for your upcoming retirement. Return the completed form to HR within 60 days of your expected retirement date.

Retirement Health Savings (RHS) Beneficiary Change Form

Use this form to update your beneficiaries for your Optum Retirement Health Savings (RHS) Plan.

Educational Assistance Form

Use this form to request reimbursement for tuition expenses. Fill out the top section and have your supervisor sign it. Then send it to HR for approval. Once a decision is made, the form will be returned to you. After you finish the class, submit the form again to your supervisor and HR with your receipts and final grade. You must earn a C or higher to be reimbursed.

Secondary Employment From

Use this form to request permission to work a job outside of your City of Auburn Hills employment, as allowed under Policy No. 30-15 of the Personnel Policy and Procedure Manual.

W4/ State Withholding Form

Click to change your tax information.

W4/ Federal Withholding Form

Click to change your tax information.

Title VI Non-Discrimination Plan