Forms

General
Benefits
Compensation/Classification
Employee Relations
Employment
Human Resource Information Systems
Payroll
PMP

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GENERAL

BENEFITS

General
		Change of Name/Address Form
Tuition Remission
		Tuition Remission
Health Benefits
		FY 2011 Regular Employee Enrollment Worksheet
		Plan Year 2011-2012 Regular Employee Enrollment Worksheet
		FY 2011 Contractual/COBRA/LAW Enrollment Worksheet
		Plan Year 2011-2012 Contractual/COBRA/LAW Enrollment Worksheet
		HIPAA Authorization Form
		CHIP Acknowledgement
Affidavit/Dependent/Certification Forms
Required Documentation for Dependents
		Certification of Dependent Eligibility
		Disabled Dependent Certification Form
		Affidavit for All Dependent Children
		Dependent Child Documentation
		Affidavit for for Domestic Partnership & Domestic Partner's Dependents
		Affidavit of Dissolution of Domestic Partnership
		Affidavit for Spousal Eligibility and Tax Status
Life Insurance
		Beneficiary Form for UNUM Term Life Insurance
		MetLife Term Life Insurance Beneficiary Form
		MetLife Statement of Health
		UNUM Term Life Enrollment Form
Disability
		UNUM Long Term Disability Enrollment Form
		UNUM Claim for Income Protection Benefits
Accidental Death & Dismemberment
		Met Life Accidental Death & Dismemberment Beneficiary Form
Flexible Spending Account
		Flexible Spending Account Direct Deposit Form
		Health Care Spending Account Claim Form
		Dependent Care Spending Account Claim Form
Leave
		Advanced Sick Leave Form
		Leave Donation Form
		Leave Reserve Fund Request Form
		Request for Extended Sick Leave Form
		Request for Family/Medical Leave (FMLA) Form Revised 5/09
		Request for Military Family/Medical Leave (FMLA) Form
		Advanced Vacation Leave

Retirement Forms
		Retirement Plan Selection Form
		ORP Retiree Health Benefits Handbook
		ORP Retiree Forms Packet
Supplemental Retirement Account Forms
		MSRP Supplemental Retirement EZ Enrollment Form
		MSRP Supplemental Retirement Plans Deferral Change Form
		TIAA-CREF 403 (b)
		Fidelity 403 (b)
		TIAA-CREF 457 (b)
		Fidelity 457 (b)

COMPENSATION/CLASSIFICATION

		Classification Action Request Form Revised 6/08
		Position Description
		UMBC Position Request Form Revised 6/08
		Summer Pay Position Request Form Revised 5/10
		Request for Approval of Acting Capacity Status Form

EMPLOYEE RELATIONS

		Disciplinary Action Form
		NOTE: Please contact the Department of Human Resources for technical assistance prior to taking any disciplinary action.

EMPLOYMENT

		Application
		Contingent I Requisition & Agreement Revised 11/11
		Personal Services Contract
		Addendum to Personal Services Contract (Regular Leave) Revised 3/09 See Contingent II Leave Benefits Memo
		Addendum to Personal Services Contract (Minimum Leave Benefits) See Contingent II Leave Benefits Memo
		UMBC Personnel Requisition Revised 6/11
		UMBC Preliminary Recruitment & Selection Report
		UMBC Hiring Exception Revised 5/11

HUMAN RESOURCES INFORMATION SYSTEMS

Report/Label Request

PAYROLL

General

Employee Payroll Information & Resources

		Change of Name/Address
		Direct Deposit	Direct Deposit Information
		FICA Student Exemption Form	Student Employment & FICA Exemption Policy
		I-9
		Savings Bond	Savings Bond Information
		W-4 - Maryland	W-4 Maryland Instructions
		W-4 - Washington DC
		W-4 - West Virginia

Payroll Preparer

Payroll Preparer Information & Resources

		Check Cancellation Form
		HR Security Access Request Form
		HR Security Access Reinstatement
		New Hire Personnel Action Request (PAR)	New Hire PAR Instructions
		Non-Resident Alien (NRA) Forms	NRA Information
		UMBC Faculty & Staff Pre-hire Form	Instructions for Faculty/Staff Pre-hire Process
		UMBC Non-Employee Data Form	Instructions for Processing Intra-Agency Faculty Process

PERFORMANCE MANAGEMENT PROCESS (PMP)

		PMP Form
		PMP Guide to Defining Performance Ratings
		PMP Rating Worksheet (Optional)