Sign our petition if you want to see good manufacturing jobs stay in the United States; if you want fair trade laws; and if you want America to keep its promise that if you work hard, you can sustain a family and one day retire with dignity.
This form is used to submit a claim for reimbursement of premiums paid by your spouse for health care coverage. Please click the PDF link below for a printable copy of this form.
Reimbursement of Spouse Premium.pdf