Management	Labor
Co-Chairman, Roger J. Giesinger, President and Chief Labor Negotiator, Hampton Roads Shipping Association	Co-Chairman, Edward L. Brown, Sr., Int'l. Vice President, Hampton Roads International Longshoremen's Association, AFL-CIO
George H. Brown, Chief Executive Officer CP&O, LLC	Ronald L. Allen, Sr., President ILA Local 1970
Kip Hinkle, Assistant Manager Virginia Intermodal Management, LLC	Larry A. Bachtell, President ILA Local 1624
Ed McCarthy, Senior Director APM Terminals	Gary W. Fitzgerald, President, ILA Local 862
Raymond A. Newlon Mid-Atlantic District, Hapag Lloyd (America), Inc.	Thomas M. Little, President ILA Local 1248
William H. Parker Ceres Marine Terminals, Inc	Jerry McMannen, President, ILA Local 1784
Joseph P. Ruddy Director of Operations and Labor Virginia International Terminals, Inc.	Robert J. Smith III, Business Agent ILA Local 970

HRSA-ILA Benefits Office

757-423-1205 IVR Map Page 1 HRSA-ILA Interactive Voice Response System Map.

IVR Map Page 2 HRSA-ILA Interactive Voice Response System Map.

HRSA-ILA Truste Page On HRSA-ILA Website.

Current Issue of Port Call Magacins. Opens Up In New Page. See Latest Newsletter Issue On Right Side Of Page.

HRSA-ILA Summary Plan Discription for Welfare Benefits
HRSA-ILA Welfare Plan Frequently Asked Questions

HRSA-ILA Summary Plan Discription For Pension Plan
HRSA-ILA Pension Frequently Asked Questions

HRSA-ILA Summary Plan Discription For Savings & Annuity Plan
HRSA-ILA Savings & Annuity Plan Frequently Asked Questions
HRSA-ILA Annuity & Savings Plan Hardship Distribution and Supporting Documentation.

HRSA-ILA Summary Plan Discription for Vacation & Holiday Benefits
HRSA-ILA Vacation & Holiday Plan Frequently Asked Questions

HRSA-ILA Summary Plan Discription for Container Royalty
HRSA-ILA Container Royalty Plan Frequently Asked Questions

HRSA-ILA Summary Plan Discription for David D. Alston Scholarship Fund
HRSA-ILA David D. Alston Scholarship Fund Frequently Asked Questions

HRSA-ILA Appeal of a Denied Claim

HRSA-ILA HIPPA Privacy Notice.

Note: The Savings & Annuity Plan Is Classified By The IRS As Defined Contribution Pension Plan, In Compliance With Section 401(k) Of The Tax Code.

HRSA-ILA Drug Protocol For Employees With A Positive Substance Abuse Test Revised April, 2006.
See Section 6, 2004-2012 ILA Master Contract For Drug & Alcohol Test Program Information.

To receive more information on the HRSA-ILA Drug and Alcohol Program, contact Peggy Rode, Drug & Alcohol Coordinator at 757-457-9112

Annuity & Savings Plan Standard Forms
Form-Annuity-1 Deferred Salary Agreement
Form-Annuity-2 Participant New Enrollment
Form-Annuity-3 Beneficiary Designation/Change
Form-Annuity-4 Investment Transfer
Form-B1 And B2 In A Single PDF File Beneficiary Designation For All Funds And Non-Spouse Beneficiary Designation, For Pension & Annuity Benefit Plan
Form-B3 Beneficiary Designation or Change

Annuity & Savings Plan Hardship Withdrawal Forms
Participant Hardship Statement. Fill Out To Take A Hardship Withdrawal From HRSA-ILA Annuity And Savings Plan.
Burial Expenses Worksheet. Hardship Withdrawal Worksheet. Submit With Participant Hardship Statement.
Casualty Repairs Worksheet. Hardship Withdrawal Worksheet. Submit With Participant Hardship Statement.
Medical Care Worksheet. Hardship Withdrawal Worksheet. Submit With Participant Hardship Statement.
Prenvention Of Eviction Or Forclosure Worksheet. Hardship Withdrawal Worksheet. Submit With Participant Hardship Statement.
Purchase Of Principal Resident Worksheet. Hardship Withdrawal Worksheet. Participant Hardship Statement.
Tuition And Related Education Fees Worksheet. Hardship Withdrawal Worksheet. Submit With Participant Hardship Statement.
Waiver of Qualified Preretirement Survivor Annuity. Spouse Waves Right To Survivor Benefit, Submit With Participant Hardship Statement.

Pension Plan Forms
Form-B1 Beneficiary Designation For All Funds, Primary & Secondary Beneficiary
Form-B2 Non-Spouse Beneficiary Designation, For Pension & Annuity Benefit
Form-B1 And B2 In A Single PDF File Beneficiary Designation For All Funds And Non-Spouse Beneficiary Designation, For Pension & Annuity Benefit Plan
Form-D1 Pension Or Medicare Direct Deposit Form
Form-D3 Authorization To Cancel Direct Deposit

Container Royalty Forms
Form-C HRSA-ILA Container Royalty Benefit Election
Form-D2 HRSA-ILA Container Royalty Or Vacation & Holiday Direct Deposit Form
Form-D3 HRSA-ILA Authorization To Cancel Direct Deposit

Direct Deposit Forms
Form-D1 HRSA-ILA Pension or Medicare Direct Deposit Form
Form-D2 HRSA-ILA Container Royalty Or Vacation & Holiday Direct Deposit Form
Form-D3 HRSA-ILA Authorization To Cancel Direct Deposit

Vacation & Holiday Forms
From-E HRSA-ILA Vacation & Holiday Benefit Election
Form-D2 HRSA-ILA Container Royalty Or Vacation & Holiday Direct Deposit Form
Form-D3 HRSA-ILA Authorization To Cancel Direct Deposit

Other HRSA-ILA Forms
Form-A HRSA-ILA Permanent Change Of Address

From-F1 HRSA-ILA Financial Aid Declaration, David D. Alston Scholarship Fund

Form-HIPPA HRSA-ILA HIPPA Privacy Notice

Cigna Appeal Forn. An Appeal Is A Request To Change A Previous Adverse Decision Made By Cigna. You Or Your Representative (Including A Physician On Your Behalf) May Appeal The Adverse Decision Related To Your Coverage.

UnumProvident Disability Claim Form May Be Needed By Your Physician. Includes Authorization To Release Medical Information.

UnumProvident Life Insurance Claim Form Must Be Turned In To HRSA-ILA.

MILA Enrollment Form.

IVR Map Page 1 HRSA-ILA Interactive Voice Response System Map.

IVR Map Page 2 HRSA-ILA Interactive Voice Response System Map.

All HRSA-ILA Forms On HRSA-ILA Web Site.

Tax Forms Local 1624 Tax Form Download Page