Human Resources Forms

Human Resources
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Form NameFile Type
Affordable Care Act Notice For Employees
Compliance Assistance Family and Medical Leave Act
CSEA LEAP Applications
CSEA Prescription Drug Co-Pay Reimbursement
Dental Claim Form (CSEA)
Dental Claim Form (MC and Council 82)
Dental Claim Form (UUP)
Dependent Care Advantage Account
Domestic Partner Instructions/Forms
Empire Plan Health Insurance Claim Form
Employee Assistance Program
Faculty & Staff Apple Discount Program
Faculty & Staff Dell Discount Program
Flexible Spending 2016 Enrollment Campaign
Health Care Spending Account
Helpful Telephone Numbers
Leave For Breast Cancer Screening
Leave For Prostate Cancer Screening
Long term Care Insurance
NYS Balance: Resources and Referral
SUNY Benefits Information
SUNY Perks
SUNY Universal Availability Notice 2015
SUNY Universal Availability Notice 2016
Tuition Waiver - MSC UUP Space Available
Tuition Waiver Form (B-140W)
UBMicro Computer and Software Discounts
Vision Claim Form (CSEA)
Vision Claim Form (MC)
Vision Claim Form (UUP)
Worker's Compensation Pharmacy Benefits
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Extra Service

Form NameFile Type
Dual Employment/Extra Service Approval Form (AC1588)
Extra Service Authorization Form
Extra Service Payroll Voucher (AC873)
UP6 Extra Service Form (M/C)
UP8 Extra Service Form (UUP)
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Form NameFile Type
Public Officers Law
Report of Accident or Injury
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Payroll Forms

Form NameFile Type
Change of Address
Direct Deposit Form (AC2772)
Employment Eligibility Verification Form (I-9)
Federal Withholding Tax Form W-4
Holiday Report
Hourly Temp Service Employee Payroll Schedule 2015
Hourly Temp Service Student Payroll Schedule 2015
NYS Withholding Tax Form IT 2104
Overtime Report
Retirement Form for Part Time Employees
Salary Reduction Agreement - SUNY 403(b) Voluntary Savings Plan
Time Sheet - Professional
Time Sheet - Classified
Time Sheet - Federal College Work Study
Time Sheet - Student Temporary Services
Time Sheet - Temporary Services
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Performance Program & Evaluation

Form NameFile Type
CSEA Performance Evaluation
UUP Performance Evaluation
UUP Performance Program
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Form NameFile Type
Appointment Action Request for Classified Service
Appointment Request Form (For Academic and Professional Staff)
Employment Application - Faculty/Professional Staff
Employment Application - Support/Classified Staff
Recruitment Authorization
Request for Volunteer Appointment
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