Due to Governor Northam's current order for Virginia to be in Stage 3 of COVID-19 recovery, City of Franklin city hall is now open to the public with social distancing and masks required. Please reserve the hours between 8:30am to 9:30am for those citizens over the age of 65 and those with compromised immune systems.
Forms
Health, Dental, Vision and Pharmacy
- 2020 - 2021 TLC Enrollment Form (USE FOR OPEN ENROLLMENT)
- 2019 -2020 TLC Enrollment Form (changes prior to July 1, 2020)
- 2020 - 2021 TLC Personal Data Change Form (effective July 1, 2020)
- 2019 - 2020 TLC Enrollment Form (changes prior to July 1, 2020)
- Prescription Drug Claim Form
- Home Delivery Order Form
Flexible Spending Account (FSA)
- FBA Benefits Card Election Form
- Employee Authorization for Payroll Deduction to Health Savings Account
- FBA FSA Enrollment Form
- FBA HSA Individual Enrollment Form
Life Insurance - Securian (Minnesota Life Website)
Voluntary Benefits
Virginia Retirement System (VRS)
- Application for Service Retirement (VRS-5)
- Certification of Hazardous Duty (VRS-77)
- Designation of Beneficiary (VRS-2)
- Designation of Beneficiary - Continuation (VRS-2A)