Forms for Download:
Benefits
Medical / Dental / Vision
- Argus Prescription Drug Claim Form
- United Concordia Companies Inc. (UCCI) Claim Form
- United Concordia Companies Inc. (UCCI) Dep. Certification Form
- United HealthCare (UHC) Claim Form
- United HealthCare (UHC) Student Certification Form
- Carefirst Claim Form
- Carefirst HIPPA Authorization Form
- Waiver of Coverage Form
- HIPAA Release Form
- Partner Affidavit
- Tax Dependent Status Form
HFS Benefits / Flexible Spending Accounts
- 2012-2013 HFS Medical FSA Claim Form
- 2012-2013 Dependent Care FSA Claim Form
- 2012-2013 HFS Substaintiation Form
- HFS Benefits Direct Deposit Form
- Grace Period Communications Form
- HFS Duplicate MBI Card Claim Form
- E-mail Debit Card Claims to HFS
Retirement
Life Insurance
Staff Leave
Miscellaneous
- UB Recreation and Wellness Center Membership Packet
- Johns Hopkins FCU Membership Application
- Loan Request Form
- Tuition Remission Form
- AFLAC Accident & Disability Claim Form
- AFLAC Instructions For Filing Claims
- AFLAC Sickness Claim Form
Employment
- Employee Action Form (EAF)
- Student Action Form (SAF)
- Faculty Action Form (FAF)
- Postion Action Form (PAF)
- Business Card Request Form + (Policy)
- New Hire Technology Set-up Request Form
- Employee Referral Data Form
- Employee Data Record
- Temporary Request Form
- Employee Emergency Contact Sheet
Payroll
- Fiscal Year 2012-2013 Payroll Calendar
- Federal Tax Form (W-4)
- I-9 Form (Employee Eligibility Verification)
- State Tax Form (MW 507)
- Direct Deposit Form
- Payroll Payment Request
- Paycheck Address Update (Change Form)
- E. Employee v. Independent Contractor Determination Form
- Professional Services Agreement (Ind. Contractor)
- Certification of Academic Activity
- W-2 Reissue Form
MICA Timesheets
- Full Time Hourly Employee
- Part Time Hourly Employee
- Part Time Campus Safety
- Model
- Student Non Work-Study
- Student Work-Study
Maps & Directions