Dental and Vision Enrollment Kit

So that we can lead you to the proper enrollment kit, please choose one of the following:

If you are enrolling yourself or family (Children under age 22), select one:

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

If you are enrolling your dependent child (age 22-27 or handicapped), select one:

I am actively employed with one of the following agencies: FBI, USSS, DEA, ATF, CBP, CIS, ICE.

I am actively employed with a Federal Agency NOT included in the above list.

I am retired from a Federal Agency.

These fillable forms are best viewed
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