UA Statewide Employee Forms (A-Z Forms Index)

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HR Forms Index

Forms Index:

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Form Name	Available Formats (Icon Legend)	Form Descriptions
8233 Form		To request a tax treaty exemption for a non- resident alien.
8233 Form Attachments		Required attachments for the 8233 form by type and country.
8233 Form Instructions		Instructions for requesting a tax treaty exemption for a non resident alien.
A		Back to Top
ACCFT Disability Leave Bank Application for Withdrawal		To request withdrawal of disability leave from ACCFT disability leave bank.
ACCFT Service Fee Deduction Form		To initiate a payroll deduction for ACCFT union service fees.
ACCFT Service Fee Revocation Form		To stop a payroll deduction for ACCFT union service fees.
ACCFT Upper Division Release		To certify agreement to belong to ACCFT while teaching upper level classes.
Alaska Administrative Code		Chapter 52 Executive Branch Code of Ethics definitions.
Alaska Executive Branch Ethics Act Quick Reference		Quick reference regarding workplace ethics.
Applicant Form		Mandatory form when applying for any UA positions.
Automatic Deposit Request Form		To add, change, or delete automatic deposit of pay to bank accounts.
B		Back to Top
Beneficiary Designation Form		To declare beneficiaries for basic life, accidental death & dismemberment, or supplemental life insurances.
Blue Cross Health Care Claim Form		To submit health care claims to Blue Cross/Blue Shield.
C		Back to Top
Change Form		To change employment ID, name, or address.
D		Back to Top
Day Counter		To assist with performing a substantial presence test for non-resident aliens.
Day Counter - Leap Year		To assist with performing a substantial presence test for non-resident aliens during leap years.
Demographic - Personal Data		To document employee demographic information.
E		Back to Top
EE/OA Form (Blue Form)		Used in the final step of the hiring process.
Employment in a Job Not Covered by Social Security		Statement to be given to employees in a job not covered by Social Security.
Employment of Immediate Family Members Disclosure Form		For UA employees to disclose the employment of immediate family members.
Employment or Service Outside UA Disclosure Form		Used for the disclosure of other employment or service.
Employment or Service Outside UA Memo		Memo regarding ethics disclosure guidelines for UA faculty and staff.
Estate Disbursal		To request dispursal of pay to employee estate (HR office use only).
Ethics Act Compliance Regarding "Works" - United Academics Faculty		Summary of UNAC faculty "Works" compliance guidance.
Ethics Determination Request Form		Confidential Request for Ethics Determination
Ethics Worksheet Answer Guide		Answers for the Executive Branch Ethics Act - Worksheet
Executive Branch Ethics Act - Worksheet		To determine an employee's understanding of the Chapter 52 Executive Branch Code of Ethics
F		Back to Top
Fidelity Beneficiary Designation Form		To declare or change beneficiaries for the Fidelity Voluntary TDA, ORP, and/or Pension plans.
Fidelity Address/Name Change Form		To change your address and/or name or provide your birthdate to Fidelity.
Fidelity Online Enrollment Guide		Fidelity enrollment instructions on opening a retirement account online.
Fidelity Transfer/Rollover Form		To move assets from another investment provider to a Fidlity retirement account or to consolidate multiple employer sponsored retirements accounts at Fidelity.
Fidelity Voluntary TDA, ORP, & Pension Plan Enrollment Form		To select investment options and beneficiary designation for the Fidelity Voluntary TDA, ORP, and/or Pension plans.
Financially Interdependent Partners (FIP) Explanation		To explain and determine FIP eligibility.
Financially InterdependentPartners (FIP) Statement		To declare FIP eligibility.
FML Leave w/o Pay (FMLWOP), Sick Leave (LWOP) Form		To request leave without pay.
FML Physician/Practitioner Cert of Health Care Form		To request leave for a serious health condition (to be completed by physician).
FML Request Form		To request leave for a serious health condition (to be completed by employee).
fsaATLAS Access Request Form		To request access to fsaATLAS.
FSA Claim For Medical And Dependent Care Form		To submit a claim for your flexible spending account.
FSA Direct Deposit For Medical And Dependent Care Form		To establish direct deposits of flexible spending account payments.
I		Back to Top
I-9 Form		To verify employment eligibility.
Independent Contractor		Form for non-resident aliens to claim independent contractor (lecturer) status.
Injury/Illness Form (Previous)		To document an injury or illness prior to employment at UA.
International Form		To determine federal tax responsibility for non-resident aliens.
International Scholarship Form		To determine federal tax responsibility for non-resident aliens on scholarships.
J		Back to Top
Job Form		To record additions, deletions, or changes to job assignments.
L		Back to Top
Labor Redistribution		To document redistribution of labor charges.
Leave Share Donation Form		To give leave donations to leave share program participants (to be completed by employee donating leave).
Leave Share Transfer Request Form		To receive leave donations from the leave share program (to be completed by employee receiving donated leave).
Leave/Earnings Adjustment		To document adjustments to leave and earnings.
Local 6070 AHECTE Membership Dues or Fees Deduction		To initiate payroll deduction for AHECTE union fees or dues.
N		Back to Top
NRA Scholarship Withholding Worksheet 2007		To determine the amount of personal allowances, if any, you may claim as deductions when calculating applicable US federal income tax withholding from your non-resident scholarship or fellowship for 2007.
NRA Workteam Contact Listing		Contact listing for the NRA Workteam.
O		Back to Top
ORP Enrollment or Fund Sponsor Change Form		To enroll in the Optional Retirement Program (ORP) or change your fund sponsor (Fidelity, TIAA-CREF, Lincoln, or Valic).
P		Back to Top
Paycheck Reissue		To document a reissue of a pay.
Payroll Adjustment		To document adjustments to a pay.
Pension/ORP Fund Sponsor Enrollment or Change Form		To select fund sponsor(s) for UA Pension and/or employee and employer contributions for ORP.
PERS/TRS Forms	External Site
PERS/TRS/ORP Option		To certify the notification of participation in the PERS, TRS, or ORP retirement plan.
PharmaCare/Caremark Physician Prior Authorization Request Form (for prescriptions)		To be completed by patient's physician - to request authorization for prescription exceptions (i.e., medication usage past certain time period, specific medication brand, etc.).
PharmaCare/Caremark Prescription Drug Forms	Caremark Site	Site contains reimbursement form for prescription drug claims; site also has other prescription related forms.
Position Description Form		To document job responsibilities (replaces JEF form).
Position Description Glossary		A listing of commonly used terms for the position description.
Position Requisition		Used to document a position request.
R		Back to Top
Relocation Allowance		To request a relocation allowance.
Retirement Plan Decision Tree (Regular Faculty or Academic Executives)		Decision tree that assists with Retirement Plan Notification Form for regular faculty or academic executives.
Retirement Plan Decision Tree (Regular Staff or Non-Academic Executives)		Decision tree that assists with Retirement Plan Notification Form for regular staff or non-academic executives.
Retirement Plan Election Form (TRS/PERS/ORP)		To elect participation in TRS, PERS, or ORP based on the employee's retirement plan eligibility.
Retirement Plan Notification Form (Regular Faculty or Academic Executives)		To notify eligible regular faculty or academic executive employees of their retirement options and elections.
Retirement Plan Notification Form (Regular Staff or Non-Academic Executives)		To notify eligible regular staff or non-academic executive employees of their retirement options and elections.
S		Back to Top
Salary Advance Request Form		To request a salary advance for extreme family emergencies.
Social Security Card Application (SS-5 Form)	External Site	Instructions and form to apply for a social security card.
Social Security Consent for Release of Information (SSA-3288 Form)		SSA consent form and instructions for SSN applicant to authorize the release of their SSN to the University of Alaska.
Student Enrollment Verification/Dependent Health Care Eligibility		To verify student enrollment and/or to notify employees of dependent (child) health care coverage eligibility.
Student Status Verification Form		Required for student employment only.
System Termination		To document termination of employment.
System Termination - Employee Information		Termination information for UA employees in letter format.
T		Back to Top
TDA Salary Reduction Agreement Form (version for 2008)		To establish or change contributions to a tax deferred annuity.
TIAA-CREF Online Enrollment Guide		TIAA-CREF enrollment instructions on opening a retirement account online.
TIAA-CREF ORP Enrollment Form		To select investment options for TIAA-CREF Optional Retirement Program (ORP).
TIAA-CREF Pension Plan Enrollment Form		To select investment options for TIAA-CREF Pension Plan.
TIAA-CREF TDA Enrollment Form		To select investment options for TIAA-CREF tax-deferred annuity (TDA).
TIAA-CREF Transfer/Rollover Authorization Form		To authorize the transfer/rollover of funds to TIAA-CREF annuities or Rollover IRA contracts.
Timesheet Exempt		To report time worked for exempt personnel classifications.
Timesheet Nonexempt		To report time worked for non-exempt personnel classifications.
TRS/ORP Option (Faculty or Academic Executives)		To certify the notification of participation in the TRS or the ORP retirement plan.
Tuition Waiver Request Form (UAA)		For use by eligible employees to waive tuition costs at UAA.
Tuition Waiver Request Form (UAF)		For use by eligible employees to waive tuition costs at UAF.
Tuition Waiver Request Form (UAS)		For use by eligible employees to waive tuition costs at UAS.
U		Back to Top
UA Choice Health Plan Enrollment Form - FY09 Open Enrollment		To enroll employee and dependents in UA health care plan for 7/1/08 through 6/30/09.
UA Choice Health Plan Enrollment Form - FY08		To enroll employee and dependents in UA health care plan for 7/1/07 through 6/30/08.
UA Choice Opt Out Form - FY09 Open Enrollment		To elect to opt out of UA health care coverage as of 7/1/08.
UA Choice Opt Out Form - FY08		To elect to opt out of UA health care coverage and verify proof of other insurance coverage for 7/1/07-6/30/08.
UA Choice Supplemental Benefit Election Form - FY09 Open Enrollment		To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/08-6/30/09).
UA Choice Supplemental Benefit Election Form - FY08		To add or delete employee selected benefits and/or deductions - i.e., FSA, AD&D, and other employee selected deductions such as accounts payable, parking, United Way, etc. (7/1/07-6/30/08).
UA Computer Account Request Form		ITS form to request access to email, Meeting Maker, domains, etc.
UA System Administrative Access Request Form		ITS form to request access to UNIX, Oracle, and SCT Banner
United Academics Adjuncts AAUP/AFT Dues Deduction		To initiate payroll deductions for United Academics Adjuncts union service fees or dues.
United Academics Dues or Agency Fee Deduction		To initiate payroll deductions for United Academics union service fees or dues.
United Academics Dues or Agency Fee Revocation		To stop payroll deductions for United Academics union service fees or dues.
V		Back to Top
Visa Classifications		Listing of visa classifications, eligibility, and benefits.
Visa Waiver Program		Document with details of the visa waiver program (VWP) and the qualifying countries.
Void Adjustment		To document a void of a payroll payment.
VSP Out-of-Network Reimbursement Form		Effective 7/1/04: To submit a claim to VSP (vision vendor) for out-of-network provider reimbursements.
W		Back to Top
W-4 Form (2008)		To declare your federal tax withholding status for 2008.
W-8BEN Form		Form to claim certification of foreign status of beneficial owner for U.S. tax withholding.
W-8BEN Instructions		W-8BEN form instructions (used to claim certification of foreign status of beneficial owner for U.S. tax withholding).
Wolfcard Payroll Deduction Form (UAA Employees Only)		To request a payroll deduction to credit your UAA Wolfcard.

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