UA Statewide Employee Forms (A-Z Forms Index)

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UA Statewide Employee Forms (A-Z Forms Index)

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HR 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
Alaska Administrative Code		Chapter 52 Executive Branch Code of Ethics definitions.
Alaska Executive Branch Ethics Act Quick Reference		Quick reference regarding workplace ethics.
Automatic (Direct) Deposit Request Form		To add, change, or delete the automatic (direct) 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
Campus Card Deduction Form		To request a payroll deduction to credit a campus card (UAA Wolfcard, UAF Polar Express card, and/or UAS Whale Card).
Caremark Prescription Claim Form		For Caremark pharmacy claims.
Change Form		To request a change to name, address, phone number, marital status, and/or Social Security number for an employee, student, and/or vendor.
COBRA Rights and Responsibilities Summary		Summary of COBRA Rights and Responsibilities.
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.
Direct Deposit Request Form		To add, change, or delete the direct deposit of pay to bank accounts.
Dummy Job Checklist for Payroll Adjustment		Checklist for Payroll to request Personnel set up a job record in order to process a payroll adjustment. (HR office use only).
E		Back to Top
Employee Selected Deduction Form		Used for optional payroll deductions not related to benefits.
Employee Work Activity Outside of Alaska Form		Used to report employee work activity outside of Alaska.
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 - Faculty		Used for the disclosure of other employment or service outside of UA for Faculty.
Employment or Service Outside UA Disclosure Form - Staff/Student		Used for the disclosure of other employment or service outside of UA for Staff and Students.
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 Disclosure - Notification of Receipt of Gift		To disclose the receipt of a gift by the employee or a member of the employee's family.
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: Q & A's		Questions and answers regarding Family Medical Leave (FML).
FML Request Form		To request FML leave for a serious health condition (to be completed by employee).
FML: Certification of Health Care Provider for Employee's Serious Health Condition	External Site	To support an employee's FMLA leave request due to the employee's own serious health condition (to be completed by the employee, employer, and the employee's health care provider).
FML: Certification of Health Care Provider for Family Member's Serious Health Condition	External Site	To support an employee's FMLA leave request due to a family member's serious health condition (to be completed by the employee, employer, and the family member's health care provider).
FML: Certification of Qualifying Exigency for Military Family Leave	External Site	To support an employee's FMLA leave request due to a qualifying military exigency (to be completed by the employee and employer).
FML: Certification for Serious Injury or Illness of Covered Servicemembers - for Military Family Leave	External Site	To support an employee's FMLA leave request due to the serious health condition of a covered servicemember (to be completed by the employee or covered servicemember, employer, and DOD health care provider).
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 Form Attachment		An Excel spreadsheet template to record additional travel dates that will not fit on the international form. This form should always be attached to an international form and never stand alone.
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.
Leave Without Pay Request Form (FML, Sick Leave, Leave of Absence)		To arrange benefit payments while on FML leave w/o pay (FMLWOP), sick leave w/o pay (SLWOP), or leave of absence w/o pay (LOAWOP).
Local 6070 Membership Dues or Fees Deduction Form		To initiate payroll deductions for Local 6070 union fees or dues.
N		Back to Top
NRA FAQ's		FAQs for Payments Made to Foreign Individuals and Foreign Entities.
NRA - Foreign Entity Form		Foreign Entity Form.
NRA - IRS Regulations for Foreign Nationals	Powerpoint	Paying Foreign Nationals and Foreign Entities: IRS Compliance.
NRA - Procedures		Payment/Contract of Foreign Entity Procedures.
NRA Scholarship Withholding Worksheet 2009		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 2009.
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	The State of Alaska Division of Retirement forms page.
PERS/TRS/ORP Option		To certify the notification of participation in the PERS, TRS, or ORP retirement plan.
PharmaCare 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 Prescription Drug Forms (Effective 7/1/06)	PharmaCare Site	Site contains reimbursement form for prescription drug claims; site also has other prescription related forms.
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 Employee Waiver Form		For student employees to request a waiver of UA Student Employment policies (e.g. minimum GPA, weekly work hours limit).
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		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.
Taxable Status Determination Form		UA form to determine taxable status of immigrants to U.S.
Tax Treaty Summary - Compensation-Related		Summary of tax treaty requirements related to nonresident alien employee compensation.
Tax Treaty Summary - Scholarship and Fellowship-Related		Summary of tax treaty requirements related to nonresident alien scholarships and fellowships.
Tax Treaty Withholding Summary - Accounts Payable		Summary of tax withholding for nonresident aliens per tax treaty.
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.
TRS/PERS Forms	External Site	The State of Alaska Division of Retirement forms page.
(Tuition) Waiver Request - UA Education Benefit		For use by eligible employees for the UA employee education benefit.
UA Approved Non-credit Courses for Fall 2009		UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit.
UA Approved Certified Public Manager (CPM) Courses		UA approved CPM courses that qualify for the UA employee education benefit.
U		Back to Top
UA Choice Enrollment Guide (For coverage effective as of July 1, 2009.)		UA Choice Enrollment Guide for plan period of July 1, 2009, through June 30, 2010.
UA Choice Health Plan Enrollment Form - FY10 (For coverage period of July 1, 2009, through June 30, 2010.)		To enroll employee and dependents in the UA health care plan for the plan period of July 1, 2009, through June 30, 2010.
UA Choice Opt Out Form - FY10 (For plan period of July 1, 2009, through June 30, 2010.)		To elect to opt out of UA health care coverage during the plan period of July 1, 2009, through June 30, 2010.
UA Choice Supplemental Benefit Election Form - FY10 (For coverage period of July 1, 2009, through June 30, 2010.)		To add or delete employee selected benefits and/or deductions (e.g. FSA, AD&D, Supplemental Life) during the plan period of July 1, 2009, through June 30, 2010.
UA Supplemental Life Evidence of Insurability (EOI) Form - FY10 (For coverage period of July 1, 2009, through June 30, 2010.)		Employees electing more than $200,000 in supplemental life coverage are required to complete the evidence of insurability form and submit it to their HR office along with with the UA Choice Supplemental Benefit Election Form.
UA Computer Account Request Form		ITS form to request access to email, Meeting Maker, domains, etc.
UAFT Disability Leave Bank - Application for Withdrawal		For UAFT employees to request withdrawal of disability leave from the UAFT Disability Leave Bank.
UAFT Disability Leave Bank - Usage Procedures		Usage procedures for a UAFT employee to request leave from the UAFT Disability Leave Bank.
UAFT Service Fee Deduction Form		To initiate a payroll deduction for UAFT union service fees.
UAFT Service Fee Revocation Form		To stop a payroll deduction for UAFT union service fees.
UA System Administrative Access Request Form		ITS form to request access to UNIX, Oracle, and SCT Banner
United Academics Adjuncts AAUP/AFT Dues or Agency Fee Deduction Form		To initiate payroll deductions for United Academics Adjuncts union dues or agency fees.
United Academics Dues or Agency Fee Deduction Form		To initiate payroll deductions for United Academics union dues or agency fees.
United Academics Dues or Agency Fee Revocation Form		To stop payroll deductions for United Academics union dues or agency fees.
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 (2009)		To declare your federal tax withholding status for 2009.
W-4 Form (NRA)		Form to declare your federal tax withholding status. Pre-completed for nonresident aliens.
W-5 Form (2009)		To request, if eligible, receipt of part of the earned income credit (EIC) in advance with your pay.
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).
W-9 Form		To Request Taxpayer Identification Number
Waiver Request - UA Education Benefit		For use by eligible employees for the UA employee education benefit.
UA Approved Non-credit Courses for Fall 2009		UA approved non-credit courses for Fall 2009 that qualify for the UA employee education benefit.
UA Approved Certified Public Manager (CPM) Courses		UA approved CPM courses that qualify for the UA employee education benefit.