University of Alaska HR Forms

Please click on a category below, or the menu to the left for the forms, or click here for a legend of the different file type icons.

Jump to HR Office Use Only Forms

Employee Forms:

Benefits Forms:
Beneficiary Designation
Financially Interdependent Partners (FIP) Explanation
Financially Interdependent Partners (FIP) Statement
FSA Claim For Medical And Dependent Care Form
FSA Direct Deposit For Medical And Dependent Care Form
Student Enrollment Verification/Dependent Health Care Eligibility
TDA Salary Reduction Agreement
Tuition Waiver (UAA)
Tuition Waiver (UAF)
Tuition Waiver (UAS)
Wolfcard Payroll Deduction Form (UAA)
UA Choice Health Plan Enrollment Form
UA Choice Opt-Out Form
UA Choice Supplemental Benefit Election Form

Employment Forms:
Applicant Form
Change Form
Demographic - Personal Data
Employment of Immediate Family Member Disclosure Form
Employment or Service Outside UA Disclosure Form
I-9 Form
Injury/Illness Form (Previous)
Social Security Card Application (External Site)
Social Security Exemption for Temporary Employees
Student Status Verification
UA Computer Account Request Form
UA System Administrative Access Request Form
W-4 Form

Ethics Forms:
Alaska Administrative Code
Alaska Executive Branch Ethics Act Quick Reference
Employment of Immediate Family Member Disclosure Form
Employment or Service Outside UA Disclosure Form
Employment or Service Outside UA Memo
Ethics Act Compliance Regarding "Works" - UNAC Faculty
Ethics Determination Request Form
Ethics Worksheet Answer Guide
Executive Branch Ethics Act - Worksheet

Flexible Spending Account Forms (FSA):
FSA Claim For Medical And Dependent Care Form
FSA Direct Deposit For Medical And Dependent Care Form
UA Choice Supplemental Benefit Election Form

Health Forms:
Blue Cross Health Care Claim Form
Blue Cross Prescription Drug Reimbursement Form
Blue Cross Secondary Insurance Prescription Drug Claim Form
Financially Interdependent Partners (FIP) Explanation
Financially Interdependent Partners (FIP) Statement
FML Leave w/o Pay (FMLWOP), Sick Leave (LWOP) Form
FML Request Form
FSA Claim For Medical And Dependent Care Form
FSA Direct Deposit For Medical And Dependent Care Form
Caremark Physician Prior Authorization Request Form (for prescriptions)
Caremark Prescription Drug Forms (External Site)
Student Enrollment Verification/Dependent Health Care Eligibility
UA Choice Health Plan Enrollment Form
UA Choice Opt-Out Form
VSP Out-of-Network Reimbursement Form

Leave Forms:
FML Leave w/o Pay (FMLWOP), Sick Leave (LWOP) Form
FML Request Form
FML Physician/Practitioner Certification of Health Care Form
Leave Share Donation Form
Leave Share Transfer Request Form

Nonresident Alien Forms (NRA):
8233 Form
8233 Form Attachments
8233 Form Instructions
Day Counter (for substantial presence test)
Day Counter - Leap Year (for substantial presence test during leap years)
fsaATLAS Access Request Form
GOA2TAX Entry
GOAINTL Entry
Independent Contractor
International Form
International Scholarship Form
NRA Scholarship Withholding Worksheet
NRA Workteam Contact Listing
Social Security Card Application (External Site)
Social Security Consent for Release of Information (SSA-3288 Form)
Taxable Status Determination Form
Taxable Status Determination Form Instructions - Individual
Taxable Status Determination Form Instructions - Department
Taxable Status Determination Form - Label
Taxable Status Determination Form - Evaluation Form
Tax Treaty Summary - Personnel/Payroll Related
Tax Treaty Summary - Scholarship/Fellowship Related
Tax Treaty Withholding Summary - Accounts Payable
Visa Classifications
Visa Waiver Program (VWP)
W-8BEN Form
W-8BEN Instructions

Payroll Forms:
Automatic Deposit Request Form
Salary Advance Request Form
Social Security Exemption for Temporary Employees
Timesheet Exempt
Timesheet Nonexempt
W-4 Form
Wolfcard Payroll Deduction Form (UAA)

Retirement & Pension Forms:
PERS/TRS Forms (External Site)
PERS/TRS/ORP Option
Pension/ORP Fund Sponsor Enrollment/Change Form (Faculty, Staff, and Executives)
Retirement Plan Decision Tree (Regular Faculty or Academic Executives)
Retirement Plan Decision Tree (Regular Staff or Non-Academic Executives)
Retirement Plan Election Form (Regular Faculty, Staff, and Executives)
Retirement Plan Notification Form (Regular Faculty or Academic Executives)
Retirement Plan Notification Form (Regular Staff or Non-Academic Executives)
TDA Salary Reduction Agreement
TIAA-CREF Online Enrollment Guide
TIAA-CREF ORP Account Enrollment Form
TIAA-CREF TDA Enrollment Form
TIAA-CREF Transfer/Rollover Authorization Form
TIAA-CREF UA Pension Plan Enrollment Form
Fidelity Beneficiary Designation Form
Fidelity Address/Name Change
Fidelity Online Enrollment Guide
Fidelity Transfer/Rollover Form
Fidelity Voluntary TDA, ORP, & Pension Plan Enrollment Form

Risk Management Forms: (External Site)
Student accident, auto claim, release and waiver, etc.

Union Forms:
ACCFT Disability Leave Bank Application for Withdrawal
ACCFT Service Fee Deduction Form
ACCFT Service Fee Revocation Form
Local 6070 AHECTE Membership Dues or Fees Deduction
United Academics Adjuncts AAUP/AFT Dues Deduction
United Academics Dues or Agency Fee Deduction
United Academics Dues or Agency Fee Revocation

HR Forms (HR Office Use Only):

Payroll Forms:
Estate Disbursal
Labor Redistribution
Leave/Earnings Adjustment
Paycheck Reissue
Payroll Adjustment
Void Adjustment

Personnel Forms:
Demographic - Personal Data
EE/OA Form (Blue Form)
Employment in a Job Not Covered by Social Security
Employment of Immediate Family Member Disclosure Form
Employment or Service Outside UA Disclosure Form
Estate Disbursal
FML Physician/Practitioner Cert of Health Care Form
I-9 Form
Injury/Illness Form (Previous)
Job Form
Position Description Form (replaces JEF)
Position Description Glossary
Position Requisition
Relocation Allowance
Social Security Card Application (External Site)
Social Security Exemption for Temporary Employees
Student Status Verification
System Termination
System Termination - Employee Information
UA Computer Account Request Form (email. Meeting Maker, domains, etc.)
UA Administrative Access Request Form (UNIX, Oracle, SCT Banner)

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Please email syhr about any problems with this page   21-Apr-2008

  Photo credits: woman in field class and woman at Sitka campus photos courtesy of UAS; Mt. McKinley photo credit © Rex Melton,
Alaska Division of Tourism; flower photo credit Nile Mueller; aurora photo credit Jan Curtis 2003