Forms

Benefits (Health Insurance, Dental, Vision, Tuition Assistance, etc.)

Address Change
CSEA Dental Claim For CSEA represented staff to submit dental expenses to the union's employee benefit fund
CSEA Full-Time Student Verification To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by the CSEA Benefit Fund
CSEA Prescription Co-Pay Reimbursement Drug Claim form for CSEA benefits fund covered prescription drug co-pay expenses
Davis Vision Student Verification Form To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by UUP, MC, PBA-NYS, NYSCOPBA and PEF dental benefits.
To request reimbursement for dependent care related expenses from your existing flexible spending account. Daycare or elder care expenses for example.
Affidavit of domestic partnership and financial interdependence. For employees in the following bargaining units: CSEA, UUP, PEF, GSEU, PBA, M/C, NYSCOPBA.
Domestic Partner Termination of Partnership (PS-425.4) To request a termination of a domestic partnership.
To request reimbursement for expenses from a non-participating health care provider.
Empire Plan Pharmacy Reimbursement Claim To request reimbursement for prescription drug expenses when paid out of pocket.
Empire Plan Pharmacy Mail Order Form To request mail order of prescription drugs.
EyeMed Full-Time Student Verification To confirm full-time student status for dependents age 19-24 when using the EyeMed vision plan. For M/C, PEF, Council 82 and NYSCOPBA only.
GA/TA Employment & Benefits Checklist For new, returning or rehired graduate and teaching assistants.
GHI Dental Claim To request reimbursement for dental claims. For GSEU, M/C, PEF, Council 82 and NYSCOPBA only.
To confirm full-time student status for dependents age 19-24. M/C, PEF, Council 82 and NYSCOPBA only.
For Graduate Student Employee Union health plan enrollment or changes.
GSEU Health Insurance Summer Continuation Notice GSEU Health Insurance Summer Continuation Notice.
To request reimbursement for health care related expenses from your existing flexible spending account.
Health insurance enrollment and changes for faculty and staff.
Form to opt out of health insurance coverage.
State University Tuition Waiver Program Application and Instructions Request reimbursement for all or part of an employee's tuition cost.
For employees represented by UUP.
Dental and vision enrollment for United University Professions (UUP) represented employees.
To notify UUP Benefit Trust Fund of marital status or dependent changes for dental and vision benefits.
UUP Delta Dental Claim For UUP represented faculty/staff to submit dental claims.
For dependents of UUP represented faculty/staff between ages 19 and 25.
For all faculty/staff represented by UUP; First UNUM Life Insurance Co.
UUP and MC Unclassified Long Term Disability Application For MC unclassified and UUP professionals.

Employment

See attached policy
Email Information for New Faculty/Staff Information on how to access your new email address at ��ý.
Employee Data Form (for Departmental use) Personal and demographic information; required for all new hires and changes in status. (.pdf)
document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States.
State Employees Lieu of Oath Certifies that a State employee has read and understands the NYS Public Officer's Law. Required for all new faculty/staff and graduate/teaching assistants and those changing official budget titles.
PA-81 Internal Application for Promotion For classified service, non-competitive, labor class promotion. Employee's status must be permanent or contingent permanent.
Phased Retirement Request For UUP and Management Confidential staff requesting to work less than full-time as near retirement.
Prior Service Credit Request for Faculty Prior service request form for faculty hired in a tenure track position.
Professional Employee Promotion/Reclassification/Salary Increase Request For non-teaching, UUP represented, professional staff. Requests accepted during appropriate window.
Faculty/Staff Handbook Receipt Acknowledgment of receipt of the Faculty and Staff Handbook information.

Hiring and Recruitment

ADA Cover Memo Americans with Disabilities Act Memo.
ADA Position Analysis Americans with Disabilities Act position analysis.
ADA Position Description Americans with Disabilities Act position description.
For search committee use. Submit to Office of Diversity, Equity & Inclusion for approval.
��ý Education History Addendum Attach as needed to the employment application form.
��ý Employment Application Application for employment.
��ý Employment History Addendum Attach as needed to the employment application form.
Professional Vacancy Worksheet To assist Human Resources with the posting of a professional vacancy. Professional Vacancy Worksheet
Recruitment Links For a list of various sources to advertise with for a position you are hiring for.
Verification of Candidate Credentials For professional vacancy search committee use.
Search Process for International Candidates Requiring Permanent Residency
Statement of Recruitment Efforts

HR Masters and Coordinators

2024-2025 Student Assistant & Federal College Work Study HR Payroll Processing Deadlines. Deadlines for HR payroll & transaction processing for the Student Assistant and Federal College Work Study payrolls.
2024-2025 Faculty/Staff and GATA Deadlines Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls.
2024-2025 Student Paycheck Dates Payroll calendar for Student Assistant & FCWS.
2024-2025 Payroll Deadlines for Timesheets Coded UUP, HRY, CLS-HRYA & CLS-HRY Payroll calendar for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY.
2023-2024 Obligation & Payroll Appointment Dates (.PDF) Document outlining obligation and appointment dates for all payrolls
2024-2025 Obligation & Payroll Appointment Dates (.PDF) Document outlining obligation and appointment dates for all payrolls
Agreement to Protect Confidential Information Agreement to protect confidential information.
Appointing to Faculty Titles Instructions on how to appoint to faculty titles.
Form to be completed by employees working for multiple state agencies.
Petition for GA/TA Dual Employment Form Form to be completed by GA/TA employees to take on additional work.
Extra Service checklist Checklist of forms to be completed to process extra service.
Extra Service Payroll Voucher (AC-873) Time record to be completed for Dual Employment Extra Service.
Extra service policy.
Extra Service Request Form Form to be completed by departments paying for on campus extra service for state employees.
UP-8 For UUP employees to request approval for extra service at another state agency.
UP-6 For Management Confidential employees to request approval for extra service at another state agency.
HR Forms "Which Form Do I Use" Instructions for which HR Form to use.
Organization Request Form Request form for creating/updating organizations.
Position Request Form for State Payrolls Position request form for all payrolls.

Immigration Services

Extend H-1B Questionnaire for department Questionnaire for extension of H-1B for department completion.
Extend H-1B Questionnaire for employee Questionnaire for extension of H-1B for employee completion.
Immigration Process for department Flow chart of immigration process for departments.
Initial H-1B Questionnaire for department Questionnaire for initial H-1B for department completion.
Initial H-1B Questionnaire for employee Questionnaire for initial H-1B for employee completion.
2024 International Tax Witholding 2024 tax withholding guide for International Students and Scholars.
Visa Options Common visa categories used to hire international employees.

Leaves

Confidential Medical Statement To be completed by a health care provider.
Confidential Medical Statement (Work Related Injury) To be completed by a health care provider for a work-related injury.
Confidential Medical Statement (CSEA only) To be completed by a health care provider for non work-related injuries (CSEA only).
Confidential Medical Statement (Cancer Screening) To be completed by a health care provider.
Family and Medical Leave Act request form.
Family and Medical Leave Act request form.
Family and Medical Leave Act request form.
Family and Medical Leave Act request form.
Leave Donation (for all bargaining units) To donate vacation leave to cover an "eligible" employee's sick leave.
To request Paid Family Leave to bond with a newborn, a newly adopted or fostered child
To request Paid Family Leave to Care for a family member with a serious health condition
To request Paid Family Leave to assist when a family member is called to active military duty or impending active duty abroad
Tenure Clock Stop Request Form Request form to stop tenure clock.
Title F Leave Request for Faculty See Faculty/Staff handbook section IV.B.2. Leave of Absence (Title F Leave).
Title F Leave Request for Professionals For UUP represented professional staff.

Miscellaneous

Child Protection Processing Guidelines Child Protection Processing Guidelines.
Volunteer Information Collection Form and Agreement Volunteer Information Collection Form and Agreement.
Online HR data report request for campus use of ��ý HR Coordinators and HR Masters only.
Workplace Violence Policy Workplace violence policy.

Offer Letter Templates

2024-2025 Letters

Payroll

For new, changes or deletions of direct deposit of your payroll into your bank account(s).
Direct Deposit Reactivate To reactive an existing direct deposit which may have lapsed. May NOT be used to start a new direct deposit allocation. Direct Deposit Reactivate
To withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.
Honoraria Payment FAQ's Frequently asked questions regarding honoraria payments.
Policy regarding honoraria payments to faculty and professional staff.
New York State, City of New York, and City of Yonkers Certificate of Nonresidence and Allocation of Withholding Tax.
To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if applicable).
To withhold the correct New York State income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.
SUNY Charitable Giving Campaign Payroll Deduction You can give to the State University of New York campus of your choice through the SUNY Charitable Giving Campaign.
Treasury Direct Deposit Form ONLY.
NYS Payroll Online Instructions Instructions on how to navigate the NYS Payroll Online system
Unclaimed Check Policy Unclaimed check policy.
W2 Reissue Request Form to request a W-2.

Performance Management

Alternate Work Location Assignment Request Form Request form for an Alternative Work Location Assignment
Classified Service Performance Program/Evaluation Performance program and evaluations for all classified service staff Classified Service Performance Program/Evaluation
Professional Employee Evaluation For non-teaching, UUP represented professional staff. Professional Employee Evaluation
Professional Employee Performance Program For non-teaching, UUP represented professional staff. Professional Employee Performance Program
For non-teaching, UUP represented professional staff
Professional Employee Self-Evaluation For non-teaching, UUP represented professional staff.
Performance Program Addendum For non-teaching, UUP represented professional staff. Used to add something to the performance program that is already in place.
PEF Performance Program and Evaluation Performance Program and Evaluation document for PEF represented employees.

Retiree Services (Forms for Retired Employees)

��ý Service Preference Checklist for ��ý retirees
Retire Contact Information Form Contact information form for ��ý retirees'
Retiree Survey Survey for ��ý retirees'
Retiree Volunteer Form Form for ��ý retiree volunteers

Retirement (Forms for Current Employees)

ERS Address Change (RS-5512) Change of address form for active Employees' Retirement System members only (not retirees).
For Tier 1 and Tier 2 Employees' Retirement System members to request a loan.
For Tier 3 and Tier 4 Employees' Retirement System members to request a loan.
NYS Employees Retirement System enrollment form.
NYS Employees Retirement System Beneficiary Form.
ERS Name Change (RS-5483-I) To notify the Employees' Retirement System of a legal name change.
Choosing an Effective Date Guide Guide to assist you with choosing the effective date for online change requests to 403(b) contributions via Retirement at Work.
to assist eligible employees with requesting to join the SUNY ORP retirement plan via Retirement at Work.
to assist employees with requesting to join ERS, PAFRS or (if eligible) TRS via Retirement at Work.
to assist you with establishing a new SUNY 403(b) voluntary savings plan
to make contribution changes to an existing SUNY 403(b) account.
Retirement System Option for Student Employees Form to acknowledge retirement system options for student employees.
Plan comparison of the Voluntary Savings Plan (403b) vs. NYS Deferred Compensation Plan (457).
NYS University Police Retirement System enrollment form.
TRS Beneficiary Designation (NET-11.4) Designation of beneficiary for active Teachers' Retirement System members only (not retirees).
For Teachers' Retirement System members to request a loan.
Teachers' Retirement System membership registration form.
To notify the Teachers' Retirement System of a legal name/address change.

Time and Attendance

Accrual rates for vacation/annual, sick and personal leave accruals.
Classified Annual Time Sheet (CLS-ANN) For classified service staff with an annual pay basis.
Classified Hourly with Attendance Rules Time Sheet (CLS-HRYA) For classified service staff with an hourly pay basis and attendance rules coverage.
Classified Hourly without Attendance Rules Time Sheet (CLS-HRY) For classified service staff with an hourly pay basis and NO attendance rules coverage.
Log-in to SUNY.edu for Time & Attendance for all Faculty.
Log-in to SUNY.edu for Time & Attendance for all federal college work-study employees.
Graduate and Teaching Assistant Time Sheet Time Sheet for graduate and teaching assistants on the 28029 payroll only.
Log-in to SUNY.edu for Time & Attendance for all Management/Confidential staff.
Log-in to SUNY.edu for Time & Attendance for UUP represented professional staff with an Annual or College Year obligation.
Time Record for Professional Non-Exempt employees.
Professional Hourly Staff Time Sheet (UUP-HRY) For UUP represented professional staff with an hourly pay basis.
Log-in to SUNY.edu for Time & Attendance for all student assistant employees.

Workers Compensation, Accidents, Accommodations

Accident or Injury Reporting (Part 1 and CS-13) To report an accident or injury on campus property/work-related.
Workers Compensation reporting procedure A document outlining the necessary steps for reporting an accident at work.
Confidential Medical Statement for Work-Related Disability A document to report a work related disability.
Estimated Capabilities Form A document to report estimated capabilities.
Reasonable Accommodation Information on Reasonable Accommodation.
Reasonable Accommodation Form Request for Reasonable Accommodation.

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