- Digital signatures are not accepted by NDPERS.
- Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
- NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.
Select a form to download:
For Dental & Vision Plans
- Application for Dependent Disability (SFN 58856)
- Authorization for Automatic Premium Deduction (SFN 50134)
- Continuation of Group Insurance Coverage - COBRA (SFN 14120)
- Dental/Vision Insurance Application or Change (SFN 58792)
- Grandchild Eligibility Verification (SFN 60983)
- Physician's Form for Dependent Disability (SFN 58798)