Office of Human Resources: Employee Benefits Forms
Below are links to some of our most requested benefits forms. If there is a form you need that is not listed here, contact the Office of Human Resources.
Forms
Alternative Retirement Plan Forms
Long-Term Disability Insurance Forms
Deferred Compensation Plan Forms
Deferred Compensation Program Application for Catch-Up
Deferred Compensation Plan Beneficiary Designation Form
Deferred Compensation Plan Enrollment Form
Deferred Compensation Plan Salary Reduction Agreement
Family and Medical Leave Act Forms
FMLA Employee Form
FMLA Family Member Form
FMLA Absence Request
SPF Employee Form (AFSCME and PSSU only)
SPF Family Member Form (AFSCME and PSSU only)
SPF Absence Request (AFSCME and PSSU only)
HIPAA Form
Return to Work Form
Flexible Spending Account Forms
Leave Donation Program Forms
Health Insurance Forms for Faculty, Managers, Nurses, Coaches and Police Officers
PASSHE Enrollment/Change Form for Managers, Faculty, Nurses, Police and Coaches
PASSHE Attestation Form for Managers, Faculty, Nurses, Police, and Coaches
PASSHE Group Healthy U Phase 4 Inquiry (Appeal) Form
Health Insurance Forms for AFSCME and SCUPA
Group Life Insurance Forms
SERS Forms
Tax-Sheltered Annuity Forms
Tuition Waiver Forms
Tuition Waiver Form (universal form – used for all semesters – Cal U classes only)
Class Schedule Form (for employees only)
Graduate Level Taxation Form and Instructions (for employees taking graduate classes only)
United Concordia Dental Forms
Voluntary Group Life/AD&D Forms
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