Human Resources Forms

Accident and Injury Forms

• Employees (pdf) (including student state workers injured on the job)
• Students & Members of the Public (pdf)

Address/Name Change & Emergency Contact Information

• Update your address with HR (pdf)
• Update your name with HR (HR will notify CIS of all name changes) (pdf)
• Add or remove emergency contacts (pdf)
• ERS - Employee Retirement System Address Change (pdf)
• TRS - Teachers' Retirement Address Change (pdf)
• TIAA-CREF address change (you will be prompted to log in)
• PFRS - Police & Fire Retirement System Address Change (pdf)
• UUP Address Change
• CSEA Address Change
• PBA Address Change  (you will be prompted to log in) 

Beneficiary Forms

• CSEA Accidental Death (log in with your CSEA ID)
• UUP Life (pdf)
• MC Life (pdf)
• TIAA (pdf)
• Employee Retirement System (pdf)
• Police and Fire Retirement System (pdf)
• Teachers Retirement System (pdf)
• NYS Deferred Compensation (pdf)

Benefits at a Glance

• CSEA Benefits at a Glance (pdf)
• MC Benefits at a Glance (pdf)
• NYSCOPBA Benefits at a Glance (pdf)
• PBANYS Benefits at a Glance (pdf)
• UUP - Full-time Benefits at a Glance (pdf)
• UUP - Part-time Benefits at a Glance (pdf)

Benefits Summaries

• CSEA - Classified Service Employees
• UUP - Faculty and Professional Staff Employees
• MC - Management Confidential Employees

Disability Accommodation Request

• Documentation of Disability (pdf)
• Request for Reasonable Accommodation Form (pdf)
• Voluntary Self-Identification of Disability (pdf) 

Discrimination/Complaints

• Charge of Civil Rights Discrimination Complaint Form (pdf)

Evaluation, Performance Program and Annual Report Forms

• Classified Service Supervisor's Probationary Report (pdf)
• CSEA Evaluation (doc)
• CSEA Performance Program (doc)
• Professional Employee Evaluation (pdf)
• Professional Performance Plan (pdf)
• Faculty Annual Report and Performance Program (pdf)
• Security Employees' Performance Program and Evaluation (pdf) 

Family Medical Leave Act Forms

• Employee Info: FMLA Rights and Responsibilities Notice (pdf)
• Employee: FMLA Notice of Eligibility (pdf)
• Human Resources: FMLA Approval/Disapproval (pdf)
• Employee/Dr: Employee's Serious Illness (pdf)
• Employee/Dr: Family Member's Serious Illness (pdf)
• Employee: Military Family Leave (pdf)
• Employee: Military Family Member's Injury (pdf) 

Health Insurance & Related Program Forms

• Empire Plan Claim (pdf)
• All Flex Spending Reimbursement Forms
• Health Insurance Enrollment/Changes (pdf) (PS 404)
• Domestic Partner Application for benefits (pdf) 

Health: Dental & Vision Claim, Student Verification Forms

MC , APSU/PBA and NYSCOPBA

• GHI Dental Claim (pdf)
• Davis Vision Claim (pdf)
• Dental Student Verification (pdf)

UUP

• Delta Dental Claim (pdf)
• Davis Vision Claim Information (pdf)

CSEA

• Look up your CSEA ID #/Order Replacement Card
• Dental Claim (pdf)
• Vision Claim (pdf)

Leave Forms

• Request For Leave Form (pdf)
• Leave Donation Form (pdf)
• Unclassified Staff Leave Report (pdf) 

Retirement Forms

• New York State Employees' Retirement System (ERS)
• New York State Teachers' Retirement System (TRS)
• Optional Retirement Program Enrollment Guide  (ORP)

Tax Withholding and Other Payroll Forms

• Payroll forms for Administrative Payroll
• Payroll forms for Student Payroll

Tuition Benefit Program

• CSEA Tuition Assistance
• SUNY Tuition Assistance Application (pdf)
• SUNY Delhi UUP Waiver Registration (pdf)
• Employee Mandatory Fee Waiver Request

Voluntary Savings Options

• SUNY 403(b) Voluntary Savings Guide
• NYS Deferred Compensation

EEOC – Know Your Rights Posting

NYS Election Law-Rules regarding time off to vote