Forms

Below is a sortable table of forms required by University Human Resources (UHR) for the many programs and services available to University of Maryland College Park employees.  If you have a question about how to fill out or the use of a form, please contact the appropriate office within UHR or by email at ContactUHR@umd.edu.

Use the search box to narrow the listing of forms or use the drop down filters to view forms by a specific department or type.

OfficeTypeFormDownload
BenefitsHealthBenefits Guide Book 2015
BenefitsHealthRegular Status Health Benefits Enrollment Form
BenefitsHealthContractual Health Benefits Enrollment Form
BenefitsHealthCOBRA Health Benefits Enrollment Form
BenefitsHealthRetiree Health Benefits Enrollment
BenefitsHealthDisabled Dependent Certification
BenefitsHealthAddress/Name ChangeOnline
BenefitsHealthContract Appointment Renewal
BenefitsHealthNotification of Termination for Benefits
BenefitsHealthHealth Insurance Portability & Accountability Act (HIPAA)
BenefitsHealthAffidavit Dependent Eligibility Tax Status
BenefitsLife/DisabilityUnum LTD Highlight Sheet
BenefitsLife/DisabilityUnum LTD Evidence of Insurability
BenefitsLife/DisabilityUNUM LTD Claim
BenefitsLife/DisabilityUnum Life Coverage Highlights
BenefitsLife/DisabilityUnum Life Beneficiary
BenefitsLife/DisabilityUnum Enrollment
BenefitsLife/DisabilityMinnesota Life Evidence of Insurability
BenefitsLife/DisabilityMinnesota Life Beneficiary Designation
BenefitsFlexible Spending Account (FSA)Connect Your Care (Dependent Claim Form)
BenefitsFlexible Spending Account (FSA)Connect Your Care (Health Claim Form)
BenefitsTuition RemissionSubmit Tuition RemissionOnline
BenefitsOptional Retirement Program (ORP)ORP Enrollment Forms
BenefitsOptional Retirement Program (ORP)Checklist of ORP Pre-Retirement Action Items
BenefitsState Retirement & Pension (SRP)Pension Pre-Retirement Checklist
BenefitsState Retirement & Pension (SRP)Pension Enrollment Form (Nonexempt)
BenefitsState Retirement & Pension (SRP)Pension Enrollment Form (Faculty / Exempt)
BenefitsSupplemental Retirement Annuity (SRA)403b Fidelity (SRA) Enrollment / Deduction Change Form
BenefitsSupplemental Retirement Annuity (SRA)403b TIAA CREF (SRA) Enrollment / Deduction Change Form
BenefitsSupplemental Retirement Annuity (SRA)457b Fidelity (SRA) Enrollment / Deduction Change Form
BenefitsSupplemental Retirement Annuity (SRA)457b TIAA-CREF (SRA) Enrollment / Deduction Change Form
BenefitsSupplemental Retirement Annuity (SRA)Maryland Supplemental Retirement Plans 401 / 457b / 403b Rollover FormOnline
BenefitsSupplemental Retirement Annuity (SRA)Maryland Supplemental Retirement Plan 401k / 457b / 403b Enrollment FormOnline
BenefitsSupplemental Retirement Annuity (SRA)Maryland Supplemental Retirement Plan 401k / 457b / 403b Change FormOnline
Information ServiceEmployee Designee Affiliate Information FormOnline
Information ServiceMailing Label Request FormOnline
Information ServiceInstructions for Employees with Prior State ServiceOnline
Information ServiceThe 3 D's List RequestOnline
Information ServicePHR Data Request FormOnline
Information ServicePHR Listserv List Request FormOnline
Information ServiceUM Data Warehouse Account Request FormOnline
Information ServicePHR Data Warehouse Client Training RegistrationOnline
EmploymentActing Capacity Form
EmploymentContingent 1 Contract Template
EmploymentContingent II Contract Template
EmploymentE-Verify FormOnline
EmploymentOverload Authorization (Non-Teaching)
EmploymentOverload Authorization (Teaching)
EmploymentPosition Description Form
EmploymentSalary Increase Approval
EmploymentStudent Wage Exemption Form
EmploymentStaff Retention Guidelines and Form
LeaveLeaveAdvanced Sick LeaveOnline
LeaveLeaveAdvanced Annual Leave
LeaveLeaveFamily and Medical LeaveOnline
LeaveLeaveStaff Parental LeaveOnline
LeaveLeaveExtended Sick Leave
LeaveLeaveLeave Reserve Fund Request
LeaveLeaveCritical Care Leave Instructions
LeaveLeaveRequest for Critical Care Leave (CCL)
LeaveLeaveMilitary Leave Recording Procedures
LeaveLeaveLeave Without Pay
Staff RelationsPRDPRD FormsClick Here
Staff RelationsDisciplinary Suspension Form
Staff RelationsGrievance Form
Staff RelationsImmediate Termination of Access Form - Involuntary SeparationOnline
PayrollFormApplication for Social Security Card
PayrollFormW-4 Employee Withholding Allowance Certificate Form - MarylandOnline
PayrollForm2014 Affidavit of Compliance
PayrollFormW2 1042S
PayrollFormI-9 Employment Eligibility Verification Form
PayrollFormI-9 Instructions
PayrollFormI-9 Central (Resources, Information, Rules)Online
PayrollFormDirect DepositDirect Deposit Form
PayrollFormAddress/Name ChangeOnline

Last updated: August 14, 2015