Employee Forms & Insurance
Creditable Coverage Disclosure Notice
W-4 Form – Federal Holding Form, to change withholding allowances, marital status, names, and address.
Direct Deposit Change Form – If you wish to change the bank in which your Check is deposited. Please print, then fill out this form and return it to the County Clerk’s office with an original voided check.
Change in Coverage Form – Use this form to make changes to your existing Health and Dental Insurance benefits through Mid-American Benefits LLC.
Point C Flexible Spending Account Information and Forms – Within this document are the forms to submit for FSA Dependent Care reimbursement and manual Health Care Reimbursement
Vision – VSP Enrollment Form – Use this form to enroll in the Vision Plan.
NIRMA (Nebraska Intergovernmental Risk Management Association) University Online Training