LENGTH OF SERVICE AWARD PROGRAM
PARTICIPANT PORTAL
Forms
Forms can be accessed and completed in two ways:
DocuSign: Complete the form entirely online using an e-signature. Clicking this button will take you to the DocuSign website, where you can complete the form. Once submitted, both Hometown Firefighters and the Sponsor will receive the electronically signed form immediately. You’ll also be able to download and save a copy for your records.
PDF File: This option opens a printable PDF version of the form, which contains fillable fields but requires a hand signature. After completing the form, you can either scan and email it to service@hometownfirefighters.com or mail it to:
Hometown Firefighters
5 Orville Drive
Bohemia, NY 11716
LOSAP Beneficiary Form
Please complete this form to designate your LOSAP beneficiaries. This form applies solely to LOSAP death benefits and does not affect any other death benefits. You may name up to two primary and three contingent beneficiaries. For additional beneficiaries, please include an addendum with the required information. If you have any questions, feel free to contact us at service@hometownfirefighters.com
Flushing Bank Direct Deposit Form
To update your direct deposit information for LOSAP payments, you can choose either the PDF form or the DocuSign option, depending on your preference. Keeping your direct deposit details current ensures timely and secure payment transfers, reducing the risk of lost or delayed checks. For assistance, feel free to reach out to our support team at
service@hometownfirefighters.com
—we’re here to help.
Change of Address Form
If you’ve recently moved or need to update your mailing address, please complete the Change of Address form. This will ensure that all important communications—such as LOSAP payments, benefits information, and other notices—are sent to your updated address.
W-9
As part of managing your benefits, you may be required to complete a W-9 form. This form is essential for ensuring that your benefits are processed correctly and that any payments or tax-related information is accurately reported to the IRS.