Health Enrollment & Affidavits
- Regular Status Health Benefits Enrollment Form
- Direct Pay Contingent II/COBRA Health Benefits Enrollment
- Retiree Health Benefits Enrollment
- Disabled Dependent Certification
- Change of Address (Benefits Office)
- Contract Appointment Renewal
- Notification of Termination for Benefits
- Health Insurance Portability & Accountability Act (HIPAA)
Life & Disability
- Unum LTD Highlight Sheet
- Unum LTD Evidence of Insurability
- UNUM LTD Claim
- Unum Life Coverage Highlights
- Unum Life Beneficiary
- Unum Enrollment
- Metlife Statement Health
- Metlife Beneficiary
- Metlife AD&D Beneficiary
Flexible Spending Accounts (FSA)
Tuition Remission
- Tuition Remission – UMCP Only (TR-ELF)
- Tuition Remission Request Form Taxability Affidavit Supervisor Certification for Non-taxable Graduate Tuition Remission and Tax Chart
Optional Retirement Program (ORP)
State Retirement & Pension (SRP)
Supplemental Retirement Annuity (SRA) Forms
- 403b Fidelity (SRA) Enrollment / Deduction Change Form
- 403b TIAA CREF (SRA) Enrollment / Deduction Change Form
- 457b Fidelity (SRA) Enrollment / Deduction Change Form
- 457b TIAA-CREF (SRA) Enrollment / Deduction Change Form
- Maryland Supplemental Retirement Plans 401 / 457b / 403b Rollover Form
- Maryland Supplemental Retirement Plan 401k / 457b / 403b Enrollment Form
- Maryland Supplemental Retirement Plan 401k / 457b / 403b Change Form
- Employee Designee Affiliate Information Form
- Mailing Label Request Form
- Instructions for Employees with Prior State Service
- The 3 D’s List Request
- PHR Data Request Form
- PHR Listserv List Request Form
- UM Data Warehouse Account Request Form
- PHR Data Warehouse Client Training Registration
- PHR/WOW Training Registration
ESOL Forms:
Performance Review & Development (PRD):
- Acting Capacity Form
- Contingent 1 Contract
- Contingent II Contract
- E-Verify Form
- Overload Authorization/Non-Teaching Assignment
- Overload Authorization/Teaching Assignment
- Position Description Form
- Request for Retention Adjustment FY2013
- Request for Staff Retention Adjustment FY2014
- Student Wage Exemption Form
- Advanced Sick Leave (Bargaining)
- Advanced Sick Leave (Non-Bargaining & Sworn Police)
- Extended Sick Leave
- Leave Reserve Fund Request
- Family and Medical Leave
- Critical Care Leave Instructions
- Request for Critical Care Leave (CCL)
- Military Leave Recording Procedures
- Leave Without Pay
- Staff Parental Leave
For assistance with these forms please contact the Payroll Office at 301-405-5665.
- 2013 Affidavit of Compliance
- Application for Social Security Card
- W-4 Employee Withholding Allowance Certificate Form – Maryland
- W-4 Employee Withholding Allowance Certificate Form – District of Columbia
- W-4 Employee Withholding Allowance Certificate Form – West Virginia
- I-9 Employment Eligibility Verification Form
- I-9 Instructions
- I-9 Central (Resources, Information, Rules)
- 2012 Citizenship Status Form
- 2013 Citizenship Status Form
- 2013 NRA Fellows Renewal Guidelines
- 2013 NRA Renewal Guidelines
- 2013 NRA Tip Sheet
- Direct Deposit Form
- Advanced Sick Leave (Bargaining)
- Advanced Sick Leave (Non-Bargaining & Sworn Police)
- Extended Sick Leave
- Leave Reserve Fund Request
- Disciplinary Suspension Form
- Request Family & Medical Leave Form (FMLA)
- Employee’s OWN Serious Health Condition
- Family Member’s Serious Health Condition
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Illness or Injury of Covered Service Member
- DOL Certification of Health Care Provider
- Critical Care Leave Instructions
- Request for Critical Care Leave (CCL)
- Certification of Qualifying Exigency
- Grievance Form
- Immediate Termination of Access Form – Involuntary Separation
- Staff Parental Leave
