Forms

Use the search box below to filter the forms table by keyword.

If you require accommodations to access any information on this webpage, please contact HR Shared Services at 315.443.4042.

Category	Form Name
Benefits: Claim Forms	Excellus BCBS Medical Claim Form
Benefits: Claim Forms	Excellus BCBS International Medical Claim Form
Benefits: Claim Forms	Excellus BCBS Dental Claim Form
Benefits: Claim Forms	WageWorks - Health Care Flexible Spending Account (FSA) Claim
Benefits: Claim Forms	WageWorks - Dependent Care Flexible Spending Account (FSA) Claim Form
Benefits: Claim Forms	Delta Dental Claim Form
Benefits: Claim Forms	Adoption Assistance Reimbursement Form
Benefits: Claim Forms	HIPAA Authorization Form for Use and Disclosure of Protected Health Information
Benefits: Claim Forms	MetLife Beneficiary Designation for Life Insurance Benefits
Benefits: Applications/Enrollment Forms	Declaration of Marriage, Domestic Partnership, or Civil Union
Benefits: Applications/Enrollment Forms	Termination of Domestic Partnership Form
Benefits: Applications/Enrollment Forms	Dependent Add/Drop Form
Benefits: Applications/Enrollment Forms	Dependent Care Subsidy Application Process
Benefits: Applications/Enrollment Forms	Schedule B Reduced Medical Contribution Application Process
Benefits: Applications/Enrollment Forms	Statement of Health for MetLife Insurance Approval (use for late enrollment or increase in coverage)
Benefits: Applications/Enrollment Forms	Medical History Statement for Long Term Disability Coverage through The Standard (use for late enrollment)
Benefits: TIAA Retirement Account	Salary Reduction Form: 403(b) Voluntary Retirement Plan (use to indicate the amount to be deducted from your paycheck to contribute to your 403(b) account)
Benefits: TIAA Retirement Account	Salary Reduction Form: 457(b) Deferred Compensation Form (use to indicate the amount to be deducted from your paycheck to contribute to your 457(b) account)
Benefits: TIAA Retirement Account	TIAA Waiver Letter and Form
Benefits: Tuition Programs	Remitted Tuition Credit Allocation
Benefits: Tuition Programs	Dependent Tuition Benefit Application Process
Benefits: Retirees	Lifetime Benefit Solutions Automatic Payment (ACH) Request Form
Benefits: Retirees	Retiree Medical Election Form
Benefits: Retirees	Retiree - Opt-In Medical Form
Benefits: Retirees	Retiree - Opt-Out Medical Form
Employee Information	Personal Information Form (PIF)
Employee Information	Employee Demographic Change Form
Compensation	Position Evaluation Request (PER) Template
SEIU Bargaining Unit	SEIU Bargaining Unit: Business Authorization/Time Record
SEIU Bargaining Unit	SEIU Bargaining Unit: Dues Deduction, Initiation Fee and Assessment Authorization
SEIU Bargaining Unit	SEIU Bargaining Unit: Affidavit of Opposite Sex Domestic Partnership
SEIU Bargaining Unit	SEIU Bargaining Unit: Statement of Termination of Domestic Partnership
Leave of Absence & Disability	Request for Paid Family Leave to Bond with a Child
Leave of Absence & Disability	Request for Paid Family Leave to Care for a Family Member with a Serious Health Condition
Leave of Absence & Disability	Request for Paid Family Leave for a Military Exigency
Leave of Absence & Disability	Application for Disability/Maternity Benefits
Leave of Absence & Disability	Return to Work: Faculty
Leave of Absence & Disability	Return to Work: Staff
Leave of Absence & Disability	Health Care Provider Release Form
Other	Data Request Form
Payroll	Direct deposit, tax withholding, reissue of W-2 forms, and more can be found under Payroll forms on the Business, Finance, and Administrative Services (BFAS) Forms page.
Performance Partnership	Performance Partnership Form
Termination/Retirement	Faculty Voluntary Phased Retirement Form
Termination/Retirement	Employee Separation Checklist
Worklife	Flexible Work Arrangement Form