Forms
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BENEFITS
- ACT Affidavit (for Tuition Waiver)
- Civil Union Certification of Tax Dependent Status
- Common Law Affidavit
- Domestic Partner Affidavit
- Domestic Partner Certification of Tax Dependent Status
- FMLA Rights and Responsibilities (explanatory poster)
- WH-381 Notice of Eligibility and Rights & Responsibilities
- WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition
- WH-380-F Certification of Health Care Provider for Family Member's Serious Health Cond.
- WH-382 Designation Notice
- WH-384 Certification of Qualifying Exigency for Military Family Leave
- WH-385 Certification for Serious Injury or Illness of Covered Service member - Military
- Former Spouse Eligibility for State Health Insurance Affidavit
- FSA (Medical and Dependent Care) Application
- Health Application/Change in Family Status
- Legal Insurance Application/Cancel Form
- Life Insurance Add/Cancel/Waive Form
- Life Insurance Beneficiary Form
- Long Term Disability Coverage Letter from Prior Employer
- Medco by Mail Order Form
- Medco Pharmacy Reimbursement Claim Form
- TreasuryDirect / Savings Bonds
- Waiver / Rescind of Health Coverage NonClassified employees
- Waiver / Rescind of Health Coverage Classified employees
GENERAL HUMAN RESOURCE FORMS
- 20 Year Certification for Statutory Status - Non Classified Employees
- Affiliate ID card, e-Campus Access or Parking Pass Application (USP-18)
- Annual Merit Performance Evaluation for BOG NonUnion NonClassified
- Application for Employment / State of RI CS14A
- Disabilities - Reasonable Accommodation for Employees with Disabilities
- Drug Free Workplace Policy
- Drug Free Workplace Policy Acknowledgement
- I-9 Employment Eligibility Form
- Incentive Credit Request CS-365
- Independent Contractor Questionnaire
- Personal Information Update Form (USP-5) (name, address, marital or veteran status)
- Personnel File Access Request
- Probationary Performance Evaluation for Non-Classified 6 Month
- Probationary Performance Evaluation for Non-Classified Final
- Request to Fill Position (RF-1)
- Sick Leave Advance Request (USP-10)
- Special Employment Request (A-64)
- Temporary/Limited Appointment Notification (USP-4)
- Terminated Employees Checklist Procedure for Supervisors
- USP-2 / USP-12 Instruction Manual
- Work Out of Classification Authorization (USP-6)
INTERNAL PAYROLL (IP-1) EMPLOYEES
- Forms and Documentation for the Internal, Student and Grad Payrolls
NEW EMPLOYEES
- Bar of Claims
- Direct Deposit Form (State Employees not Internal Payroll Employees)
- Drug Free Work Place Acknowledgement
- Drug Free Work Place Policy
- I-9 Employment Eligibility Form
- W-4 Federal Form - 2013
- W-4 Rhode Island Form
PAYROLL
- Additional Pay Form for URI Faculty/Staff (APF-3)
- Additional Compensation for Staff (USP-7)
- Direct Deposit Form (State Employees not Internal Payroll Employees)
- In-House Payroll Correction Form (Internal and Student employees)
- IP-1 Form - Internal Payroll Form
- Lecturer Salary Payment Option (Full Academic Year)
- Maternity Leave Accrued Hours Discharge Request (USP-21)
- Paycheck Distribution Authorization Form
- Summer Recontracting - SR-1 and Instructions
- W-4 Federal Form - 2013
- W-4 Rhode Island Form
- Taxpayers Identification Number and Certification Request (W-9)
RETIREMENT
- 403 (b)Group Supplemental Retirement Application TIAA-CREF (GSRA)
- 403 (b) Group Supplemental Retirement Annuity Agreement (PF-15)
- 403 (b) Group Supplemental Retirement Annuity Change for (PF-16)
- 403 (b) Retirement Authorization Form PF 14
- 457 Deferred Compensation Authorization Form for NONCLASSIFIED employees
- 457 Deferred Compensation Authorization Form for CLASSIFIED employees
- ERSRI (Employee Retirement System of RI) Beneficiary Form
- ERSRI Change of Information Form
- TIAA Beneficiary Form for 403(b)
- TIAA Beneficiary Form for 401(a)
WORKERS COMPENSATION
- 24 Hour Notification to be completed by Supervisor
- Confidential Information Authorization Release
- Employee Certificate of Dependency Status
- Sick Leave/Payroll Discharge Form
- Incident/Injury Report URI Form
- W-9 completed by students or internal employees who are injured
