The VSP Video Display Terminal (VDT) Confirmation Form is only provided to CSU employees who meet the necessary job requirements as determined by the CSU campus benefits office. This form must be completed by the employee and provided to a VSP Select Network doctor to receive the supplemental VDT benefit.

Employee will need to initiate the form and send it to supervisor for review/approval. Supervisor will need to send the completed form to Ariel.Aaron@humboldt.edu. Please make sure the time is also claimed in Absence Management or claimed on the employee's timesheet