Human Resources Forms
Below is a comprehensive listing of Human Resources related forms
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This table contains downloadable forms and documents:
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Address Change | (.pdf, 77kb) | (.doc, 41kb) | ||
| CHOICES Health Insurance Booklet 2020 |
For Employees of the State of New York who are unrepresented or in Negotiating Units that have agreements/awards with New York State effective October 1, 2011 or later, Employees of Participating Employers, and for COBRA enrollees with their NYSHIP benefits | (.pdf) | ||
| CSEA Dental Claim | For CSEA represented staff to submit dental expenses to the union's employee benefit fund | (.pdf, 1.9mb) | ||
| CSEA Full-Time Student Verification | To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by the CSEA Benefit Fund | (.pdf, 523kb) | ||
| CSEA Prescription Drug Co-Pay Reimbursement |
Claim form for CSEA benefits fund covered prescription drug co-pay expenses | (.pdf, 120kb) | ||
| Davis Vision Student Verification Form | To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by UUP, MC, PBA-NYS, NYSCOPBA, and PEF dental benefits | (.pdf, 120kb) | ||
| Dependent Care Advantage Account Reimbursement (Flexible Spending) |
To request reimbursement for dependent care related expenses from your existing flexible spending account. Daycare or elder care expenses for example. | (pdf) | ||
| Domestic Partner Application for Benefits (PS-425) |
Affidavit of domestic partnership and financial interdependence. For employees in the following bargaining units: CSEA, UUP, PEF, GSEU, PBA, M/C, NYSCOPBA | (.pdf, 71.6kb) | ||
| Domestic Partner Termination of Partnership (PS-425.4) | To request a termination of a domestic partnership | (.pdf,52.1b) | ||
| Empire Plan Non-Participating Claim |
To request reimbursement for expenses from a non-participating health care provider | (.pdf, 52.4kb) | ||
| Empire Plan Pharmacy Reimbursement Claim |
To request reimbursement for prescription drug expenses when paid out of pocket | (.pdf, 73.6kb) | ||
| Empire Plan Pharmacy Mail Order Form | To request mail order of prescription drugs | (.pdf .71.3kb) | ||
| EyeMed Full-Time Student Verification |
To confirm full time student status for dependents age 19-24 when using the EyeMed vision plan. For M/C, PEF, Council 82 and NYSCOPBA only. | (.pdf, 37.2kb) | ||
| GA/TA Employment & Benefits Checklist - New |
For new graduate and teaching assistants | link | ||
| GA/TA Employment & Benefits Checklist - Returning |
For returning or rehired graduate and teaching assistants | link | ||
| GHI Dental Claim | To request reimbursement for dental claims. For GSEU, M/C, PEF, Council 82 and NYSCOPBA only | (.pdf, 53.2kb) | ||
| GHI Full-Time Student Verification |
To confirm full time student status for dependents age 19-24. M/C, PEF, Council 82 and NYSCOPBA only. | (.pdf, 90.1kb) | ||
| GSEU Health Insurance Transaction Form (PS-404G) |
For Graduate Student Employee Union student employee health plan enrollment or changes | (.pdf,) | ||
| GSEU Health Insurance Enrollment Instructions for PS-404G |
Instructions for completing the form PS-404G GSEU Health Insurance Enrollment Form | (.pdf,) | ||
| GSEU Health Insurance Summer Continuation Notice | GSEU Health Insurance Summer Continuation Notice | (.pdf) | ||
| Health Care Spending Account Reimbursement (Flexible Spending) |
To request reimbursement for health care related expenses from your existing flexible spending account. | (.pdf, 28.5kb) | ||
| Health Insurance Transaction Form (PS-404) | health insurance enrollment and changes for Faculty and Staff | (.pdf, 28.5kb) | ||
| Health Insurance Opt Out Attestation (PS-409) | Form to opt out of health insurance coverage | .pdf, 44kb) | ||
| Medco Plan Mail-In Prescription Request |
Mail order prescription request form | (.pdf, 50.9kb) | ||
| Space Available Program Application and Instructions - for courses taken at Binghamton University; refer to instructing campus website or HR office for their application process |
For UUP represented faculty/staff only; allows employees in the UUP bargaining unit to take one course per semester provided there is space available in the desired course | Link | ||
| State University Tuition Waiver Program Application and Instructions | Request reimbursement for all or part of an employee's tuition cost. | |||
| UUP Benefit Fund Address Change |
For employees represented by UUP | (.pdf, 57.7kb) | ||
| UUP Benefit Trust Fund Enrollment |
Dental and vision enrollment for United University Professions (UUP) represented employees | (.pdf, 56.3kb) | ||
| UUP Benefit Trust Fund Marital Status or Dependent Change |
To notify UUP Benefit Trust Fund of marital status or dependent changes for dental and vision benefits | (.pdf, 66.8kb) | ||
| UUP Delta Dental Claim | For UUP represented faculty/staff to submit dental claims effective 4/1/2008 | (.pdf, 56.7kb) | ||
| UUP Full-Time Student Verification |
For dependents of UUP represented faculty/staff between ages 19 and 25 | (.pdf,47.4kb) | ||
| UUP Group Life Beneficiary Designation |
For all faculty/staff represented by UUP; First UNUM Life Insurance Co. | (.pdf, 27.9kb) | ||
| UUP and MC Unclassified Long Term Disability Application | For MC unclassified and UUP professionals | (.pdf, 334kb) |
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|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Alternate Work Options | See attached policy | Link | ||
| Email Information for New Faculty/Staff | Information on how to access your new email address at Binghamton University | (.pdf, 23kb) | ||
| Employee Information Form | Personal and demographic information; required for all new hires and changes in status | (.pdf, 5.1mb) | (.doc, 1.1mb) | |
| I-9 Employment Eligibility | To document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. | (.pdf, 39.8mb) | ||
| State Employee Statement in Lieu of Oath | Certifies that a State employee has read and understands the NYS Public Officer's Law. Required for all new faculty/staff and graduate/teaching assistants and those changing official budget titles. | Link | ||
| PA-81 Internal Application for Promotion |
For classified service, non-competitive, labor class promotion. Employee's status must be permanent or contingent permanent. | (.pdf, 48.7kb) | ||
| Phased Retirement Request | For UUP and Management Confidential Staff requesting to work less than full-time as near retirement | (.pdf, 34.0kb) | ||
| Prior Service Credit Request for Faculty | Prior service request form for faculty hired in a tenure track position | (.pdf, 27.6kb) | (.doc, 236kb) | |
| Professional Employee Promotion/Reclassification/Salary Increase Request | For non-teaching, UUP represented, professional staff. Requests accepted during appropriate window. | (.pdf, 83kb) | (.doc, 85.5kb) | |
| Faculty/Staff Handbook Receipt | Acknowledgment of receipt of the Faculty and Staff Handbook information. | (.doc, 56.2kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| ADA Cover Memo | Americans with Disabilities Act Memo | (.pdf, 39.2kb) | (.doc, 48.6kb) | |
| ADA Position Analysis | Americans with Disabilities Act position analysis | (.pdf, 18.7kb) | (.doc, 35.8kb) | |
| ADA Position Description | Americans with Disabilities Act position description | (.pdf, 10.5kb) | (.doc, 27.1kb) | |
| Office of Diversity, Equity & Inclusion (DDEI) Hiring Guides and Resources |
For search committee use. Submit to Office of Diversity, Equity & Inclusion for approval | Link | ||
| Binghamton University Education History Addendum |
Attach as needed to the employment application form | (.pdf, 68.3kb) | (.doc, 10.3mb) | |
| Binghamton University Employment Application |
Application for employment | (.pdf, 10.5mb) | (.doc, 24.8mb) | |
| Binghamton University Employment History Addendum |
Attach as needed to the employment application form | (.pdf, 61.4kb) | (.doc, 97.3kb) | |
| Professional Vacancy Worksheet | To assist Human Resources with the posting of a professional vacancy | (.pdf, 50.9kb) | (.doc, 59.4kb) | |
| Recruitment Links | For a list of various sources to advertise with for a position you are hiring for | (.pdf, 18kb) | (.doc, 20kb) | |
| Verification of Candidate Credentials |
For professional vacancy search committee use | (.pdf, 45.8kb) | (.doc, 85.0kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| 2018-2019 Faculty/Staff & GA/TA HR Transaction Processing Deadlines | Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls | (.xls, 44 kb) | ||
| 2019-2020 Faculty/Staff & GA/TA HR Transaction Processing Deadlines | Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls | (.xls, 31 kb) | ||
| 2018-2019 Student Assistant & Federal College Work Study HR Payroll Processing Deadlines | Deadlines for HR payroll & transaction processing for the Student Assistant and Federal College Work Study payrolls | (.pdf, 80 kb) | ||
| 2019-2020 Student Assistant & Federal College Work Study HR Payroll Processing Deadlines | Deadlines for HR payroll & transaction processing for the Student Assistant and Federal College Work Study payrolls | (.pdf, 217 kb) | ||
| 2019-2020 Student Paycheck Dates | Payroll calendar for Student Assistant & FCWS | .pdf, 80 kb) | ||
| 2018-2019 Payroll Deadlines for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY | Payroll calendar for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY | (.pdf, 74 kb) | (.xls, 46 kb) | |
| 2018-2019 Faculty, Staff & GA/TA Lag Payroll Calendar | Payroll calendar for Faculty, Staff and GA/TA lag payrolls | Link | ||
| 2018-2019 Obligation & Payroll Appointment Dates | Document outlining obligation and appointment dates for all payrolls | (.pdf, 73kb) | (.xls, 44kb) | |
| 2019-2020 Obligation & Payroll Appointment Dates | Document outlining obligation and appointment dates for all payrolls | (.pdf, 72kb) | (.xls, 47kb) | |
| 2019-2020 Payroll Deadlines for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY | Payroll calendar for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY | (.pdf, 72kb) | ||
| Agreement to Protect Confidential Information | Agreement to protect confidential information | (.pdf, 56.6kb) | ||
| Appointing to Faculty Titles | Instructions on how to appoint to faculty titles | (.pdf, 27.2kb) | ||
| Dual Employment Form (AC-1588) | Form to be completed by employees working for multiple state agencies | (.pdf, 14.9kb) | ||
| Extra Service Checklist | Checklist of forms to be completed to process extra service | (.pdf, 29.5kb) | ||
| Extra Service Payroll Voucher (AC-873) | Time record to be completed for Dual Employment Extra Service | (.pdf, 14.0kb) | ||
| Extra Service Policy | Extra service policy | Link | ||
| Extra Service Request Form | Form to be completed by departments paying for on campus extra service for state employees | (.pdf, 50.0kb) | ||
| UP-8 | For UUP employees to request approval for extra service at another state agency | (.pdf, 12.1kb) | ||
| UP-6 | For Management Confidential employees to request approval for extra service at another state agency | (.pdf, 13.7kb) | ||
| HR Forms Training PowerPoint | Training manual for HR Forms | (.ppt, 1645kb) | ||
| HR Forms "Which Form Do I Use" | Instructions for which HR Form to use | (.pdf, 56kb) | ||
| Organization Request Form | Request form for creating/updating organizations | (.pdf, 108 kb) | (.doc, 18 kb) | |
| Position Request Form for State Payrolls | Position request form for all payrolls | Link |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Extend H-1B Questionnaire for department | Questionnaire for extension of H-1B for department completion | (.pdf, 9.3kb) | ||
| Extend H-1B Questionnaire for employee | Questionnaire for extension of H-1B for employee completion | (.pdf, 11.2kb) | ||
| Immigration Process for department | Flow chart of immigration process for departments | (.pdf, 74.4kb) | ||
| Initial H-1B Questionnaire for department | Questionnaire for initial H-1B for department completion | (pdf) | ||
| Initial H-1B Questionnaire for employee | Questionnaire for initial H-1B for employee completion | (pdf) | ||
| Tax Withholding Guide for International Students and Scholars | 2019 tax withholding guide for International Students and Scholars | (.pdf, 14kb) | (.doc, 39kb) | |
| Visa Options | Common visa categories used to hire international employees | (.pdf, 79kb) | (.doc, 122mb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Confidential Medical Statement | To be completed by a health care provider | (.pdf) | (.doc, 41.7kb) | |
| Confidential Medical Statement (Work Related Injury) |
To be completed by a health care provider for a work-related injury | (.pdf, 117 kb) | (.doc, 42.1kb) | |
| Confidential Medical Statement (CSEA only) | To be completed by a health care provider for non work-related injuries (CSEA only) | (.pdf, 116 kb) | (.doc, 39.8kb) | |
| Confidential Medical Statement (Cancer Screening) | To be completed by a health care provider | (.pdf, 115 kb) | (.doc, 41 kb) | |
| FMLA - Employee's Serious Health Condition | Family and Medical Leave Act request form (pdf) | Link | ||
| FMLA - Family Member's Serious Health Condition | Family and Medical Leave Act request form (pdf) | Link | ||
| FMLA - FMLA Illness of Covered Servicemember for Military Family Leave | Family and Medical Leave Act request form (pdf) | Link | ||
| FMLA - FMLA Qualifying Exigency for Military Family Leave | Family and Medical Leave Act request form (pdf) | Link | ||
| Leave Donation (for all bargaining units) |
To donate vacation leave to cover an "eligible" employee's sick leave | (.pdf, 15.1kb) | (.doc, 31.2kb) | |
| Tenure Clock Stop Request Form | Request form to stop tenure clock | (.pdf, 78 kb) | (.doc, 324 kb) | |
| Title F Leave Request for Faculty | See Faculty/Staff handbook section IV.B.2. Leave of Absence (Title F Leave) | (.pdf, 25 kb) | (.doc, 40.5kb) | |
| Title F Leave Request for Professionals |
For UUP represented professional staff | (.doc, 26.1kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Child Protection Processing Guidelines | Child Protection Processing Guidelines | (.pdf, 341 kb) | (.doc, 271 kb) | |
| Volunteer Information Collection Form and Agreement | Volunteer Information Collection Form and Agreement | (.pdf, 113 kb) | ||
| HR Data Report Request | Online HR data report request for campus use of Binghamton University HR Coordinators and HR Masters only | Link | ||
| STAR Recognition Program Nomination |
To nominate a campus employee for the STAR employee recognition award | (.pdf, 20.7kb) | (.doc, 24.2mb) | |
| Workplace Violence Policy | Workplace violence policy | (.pdf) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Direct Deposit (AC-2722) | For new, changes or deletions of direct deposit of your payroll into your bank account(s) | (.pdf, 26.4mb) | ||
| Direct Deposit Reactivate | To reactive an existing direct deposit which may have lapsed. May NOT be used to start a new direct deposit allocation. | (.pdf, 38.9kb) | (.doc, 52.7kb) | |
| Federal Tax Form W-4 | To withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. | Link | ||
| Honoraria Payment FAQ's | Frequently asked questions regarding honoraria payments | (.doc, 26.1kb) | ||
| Honoraria Payment Policy | Policy regarding honoraria payments to faculty and professional staff | Link | ||
| New York State Certificate of Nonresidence and Allocation of Withholding Tax (IT-2104.1) |
New York State, City of New York, and City of Yonkers Certificate of Nonresidence and Allocation of Withholding Tax | Link | ||
| New York State Tax Certificate of Exemption (IT-2104-E) |
To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if applicable) | Link | ||
| New York State Tax Form (IT-2104) |
To withhold the correct New York State income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes | Link | ||
| SUNY Charitable Giving Campaign Payroll Deduction |
You can give to the State University of New York campus of your choice through the SUNY Charitable Giving Campaign. | (.pdf, 54.5kb) | ||
| Treasury Direct Direct Deposit Form | Treasury Direct Direct Deposit Form ONLY | (.pdf, 31kb) | ||
| Unclaimed Check Policy | Unclaimed check policy | (.pdf, 21.5kb) | (.doc, 32.3kb) | |
| W2 Reissue Request | Form to request a W-2 | (.pdf, 50.4kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Alternate Work Location Assignment Request Form | Request form for an Alternative Work Location Assignment | (.pdf, 111kb) | (.doc, 42kb) | |
| Classified Service Performance Program/Evaluation |
Performance program and evaluations for all classified service staff | (.pdf, 12.0mb) | (.doc, 95.2kb) | |
| Professional Employee Evaluation |
For non-teaching, UUP represented professional staff | (.pdf, 10.7 mb) | (.doc, 84.5kb) | |
| Professional Employee Performance Program |
For non-teaching, UUP represented professional staff | (.pdf, 66.9kb) | (.doc, 24.7mb) | |
| NEW Online Professional Employee Performance Program | For non-teaching, UUP represented professional staff | Link | ||
| Professional Employee Self-Evaluation |
For non-teaching, UUP represented professional staff | (.pdf, 44.9kb) | (.doc, 24.3mb) | |
| Performance Program Addendum | For non-teaching, UUP represented professional staff. Used to add something to the performance program that is already in place. | (.pdf, (18.5kb) | (.doc, 212kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Binghamton University Service Preference | Checklist for Binghamton University retirees | Link | ||
| Retire Contact Information Form | Contact information form for Binghamton University retirees' | Link | ||
| Retiree Survey | Survey for Binghamton University retirees' | Link | ||
| Retiree Volunteer Form | Form for Binghamton University retiree volunteers | Link |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| ERS Address Change (RS-5512) |
Change of address form for active Employees' Retirement System members only (not retirees) | (.pdf, 24.6kb) | ||
| ERS Loan Application Tiers 1 & 2 (RS-5025) |
For Tier 1 and Tier 2 Employees' Retirement System members to request a loan | Link | ||
| ERS Loan Application Tiers 3 & 4 (RS-5025-A) |
For Tier 3 and Tier 4 Employees' Retirement System members to request a loan | Link | ||
| ERS Membership Application & ERS Beneficiary Designation Form | Employees' Retirement System membership registration form | Beneficiary Form Link | ERS Application Link | |
| ERS Name Change (RS-5483-I) |
To notify the Employees' Retirement System of a legal name change | (.pdf, 37.2kb) | ||
| Retirement@Work Participant Quick Reference Guide | Access to Retirement@Work online registration system and initial retirement plan enrollment (or declination) instructions | Link | ||
| Retirement@Work Tax Deferred Annuity (TDA) Enrollment Guide | Instructions for enrolling in the SUNY 403(b) Voluntary Savings Plan | Link | ||
| Retirement@Work Making Account Changes Guide | Instructions for making changes to your existing SUNY ORP and/or 403(b) Voluntary Savings Plan contributions | Link | ||
| Retirement@Work ORP Enrollment Guide | Instructions to enroll in the SUNY Optional Retirement Program (ORP) NOTE: eligibility rules apply | Link |
||
| Retirement@Work Tax Deferred Annuity (TDA) Choosing an Effective Date Guide |
Guide to assist you with choosing the effective date for online change requests to 403(b) contributions | |||
| Retirement System Option for Student Employees | Form to acknowledge retirement system options for student employees | (.pdf, 60.2kb) | ||
| SUNY Voluntary Savings Plans Comparison | Plan comparison of the Voluntary Savings Plan (403b) vs. NYS Deferred Compensation Plan (457) | Link | ||
| Police & Fire Retirement System Membership Application | NYS University Police Retirement System enrollment form | (.pdf) | ||
| TRS Beneficiary Designation (NET-11.4) |
Designation of beneficiary for active Teachers' Retirement System members only (not retirees) | (.pdf, 52.6kb) | ||
| TRS Loan Application (LON-26) |
For Teachers' Retirement System members to request a loan | Link | ||
| TRS Membership Application | Teachers' Retirement System membership registration form | Link | ||
| TRS Member Name/Address Change | To notify the Teachers' Retirement System of a legal name/address change | Link |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Accruals by Bargaining Unit | Accrual rates for vacation/annual, sick and personal leave accruals | Link | ||
| Classified Annual Time Sheet (CLS-ANN) |
For classified service staff with an annual pay basis | (.pdf, 143kb) | (.doc, 10.1mb) | |
| Classified Hourly with Attendance Rules Time Sheet (CLS-HRYA) |
For classified service staff with an hourly pay basis and attendance rules coverage | (.pdf, 37.3kb) | (.doc, 13.7mb) | |
| Classified Hourly without Attendance Rules Time Sheet (CLS-HRY) | For classified service staff with an hourly pay basis and NO attendance rules coverage | (.pdf, 14.7kb) | (.doc, 91.6kb) | |
| Faculty Time & Attendance | Log-in to SUNY.edu for Time & Attendance for all Faculty | Link | ||
| Federal College Work Study (28023) Time Sheet |
Time Sheet for students of the federal college work-study payroll (28023) only | (.pdf, 11.6mb) | (.doc, 25.8mb) | |
| Graduate and Teaching Assistant Time Sheet |
Time Sheet for graduate and teaching assistants on the 28029 payroll only. | Link | ||
| Management Confidential (M/C) Time & Attendance |
Log-in to SUNY.edu for Time & Attendance for all Management/Confidential staff | Link | ||
| Professional Annual and College Year Staff Time & Attendance |
Log-in to SUNY.edu for Time & Attendance for UUP represented professional staff with an Annual or College Year obligation | Link | ||
| Professional Non-Exempt Time & Attendance |
Time Record for Professional Non-Exempt employees | Link | ||
| Professional Hourly Staff Time Sheet (UUP-HRY) |
For UUP represented professional staff with an hourly pay basis | (.pdf, 17.3kb) | (.doc, 25.9mb) | |
| Student Assistant (28021) Time Sheet | Time Sheet for students on the student assistant payroll (28021) only | (.pdf, 26.0kb) | (.doc, 277kb) | |
| Classified Accrual Instructions | Accrual instructions for classified employees | (.pdf, 56.8kb) | ||
| Faculty Accrual Instructions | Accrual instructions for faculty | (.pdf, 52.2kb) | ||
| Graduate Student Accrual Instructions | Accrual instructions for graduate students | (.pdf, 48.8kb) | ||
| M/C Professional Accrual Instructions | Accrual instructions for M/C professional employees | (.pdf, 79.8kb) |
|
Form or Document Name |
Description |
|
Word/Excel |
Link |
| Accident or Injury Reporting (Part 1 and CS-13) | To report an accident or injury on campus property/work-related | (.pdf, 32.30mb) | ||
| Workers' Compensation Reporting Procedures |
A document outlining the necessary steps for reporting an accident at work | (.pdf, 22kb) | ||
| Confidential Medical Statement for Work-Related Disability | A document to report a work related disability | (.pdf, 86.3kb) | ||
| Estimated Capabilities Form | A document to report estimated capabilities | (.pdf, 111kb) | ||
| Reasonable Accommodation | Information on Reasonable Accommodation | .pdf, 99 kb) | (.doc, 13kb) | |
| Reasonable Accommodation Form | Request for Reasonable Accommodation | (.pdf, 19kb) |