Turn your PDF into an API-fillable template in seconds. No signup required.
Try it now
Turn your PDF into an
API-fillable template in
seconds
Upload any PDF to see Anvil's Document AI in action. No signup required.
Products
Workflows
Automate complex document processes
Etch E-sign
Embed white-labeled e-signatures
PDF Services
Fill PDFs with collected or stored data
Webforms
Collect data with mobile-friendly webforms
Document AI
Faster way to build workflows
Document SDK
All you need to automate documents
Industries
Insurance
Rate, quote, and bind faster
Human resources
Automate onboarding documents
Real estate
Secure workflows for buying, selling, renting
Healthcare
Launch HIPAA compliant document workflows
Finance
Automate documents for financial products
Case studies
Learn how businesses have grown with Anvil
Resources
Form library
Ship faster with pre-made form templates
Blog
New features, industry news, customer stories
Help center
Step-by-step guides for using Anvil
Product updates
New features & app improvements
Ask Anvil
Answers to your paperwork questions
Features
Overview of all Anvil features
Developers
Get started
A quick introduction to building with Anvil
Documentation
Learn how to build Anvil into your product
API reference
GraphQL types, queries, & more
Open source
Pre-written clients to simplify development
Engineering blog
Technical topics, how-tos, & more
Pricing
Try it free
Get a demo
Products
Industries
Resources
Developers
Pricing
Login
Try it free
Dependent Day Care Claim Form
One API call is all it takes. Free to use.
Fill it over API
Download fillable PDF
AI-generated
4.8 Stars
Form for submitting dependent day care expenses for reimbursement through a flexible spending account.
Fill over API
Get it e-signed
Build document flow
Fill out your PDF over API
Send JSON, fill PDF
. It's that simple.
Fast and scalable PDF filling.
Quick
AI-assisted
template setup.
Get started for free
Get your PDF filled and signed
Request e-signatures over
API
.
Save time (& sanity) with
Document AI
.
Style
&
embed
e-sign into your application.
Get started for free
Automate your document flows
Generate
production-ready Webforms
from PDFs in seconds.
Collect reusable, structured data.
Customize document workflows without code.
Get started for free
See other related forms
VSP Materials Invoice
PDF template
Detailed instructions for completing and submitting a VSP Materials Invoice for optical services and reimbursement.
See template
See template
Kentucky House Bill 387 Employee And Contractor Reporting Act
PDF template
Kentucky legislative act requiring quarterly reporting of full-time employees and contractors across state government executive branches.
See template
See template
Employee Off Boarding Checklist
PDF template
Comprehensive checklist for managing employee departure processes, covering administrative, procurement, IT, and property return requirements.
See template
See template
PKT Enterprises Time Off Request Form
PDF template
A formal document for employees to request time off, outlining procedures for shift coverage and approval process.
See template
See template
190 Employee Expenses Policy
PDF template
Policy outlining guidelines for employee expense reimbursement for travel and business-related expenses at the college.
See template
See template
Travel Policy
PDF template
Policy establishing regulations and procedures for authorized travel and reimbursement for Leon County officials, employees, and authorized persons.
See template
See template
FY 2024 Kyoto City Livelihood Support Benefit (Adjustment Benefit) Application Form
PDF template
Application form for residents of Kyoto City seeking livelihood support benefits based on changes in income or tax situation for fiscal year 2024.
See template
See template
Travel Policy Guidelines
PDF template
Policy defining travel authorization, approval process, and expense reimbursement for Niagara Frontier Transportation Authority employees and commissioners.
See template
See template
Assistance Programs Application
PDF template
An application form for various social assistance programs including TANF, SNAP, Refugee Cash Assistance, and other support services.
See template
See template
Child Registration Form
PDF template
Comprehensive registration form for child day care centers collecting child and parent information, emergency contacts, and medical details.
See template
See template
Emergency Contact Form
PDF template
A form for county employees to provide emergency contact details and personal contact information for use during work-related emergencies.
See template
See template
Recreational Trails Program Reimbursement Request Guide
PDF template
Guide for submitting reimbursement requests for the Virginia Department of Conservation and Recreation's Recreational Trails Program.
See template
See template
General Personnel Expenses
PDF template
Policy governing employee expense reimbursement, advancement, and purchase order procedures for the South Eastern Special Education District.
See template
See template
560 Expenses
PDF template
A detailed policy governing employee travel, meal, and lodging expense reimbursement, including guidelines for advancements and documentation requirements.
See template
See template
Authorization For Direct Deposits Employee Form
PDF template
Form for employees to authorize direct deposit of payroll into one or two bank accounts.
See template
See template
Welcome To Your Job As An In Home Supportive Services (IHSS) Individual Provider
PDF template
A notice describing benefits and tax responsibilities for In-Home Supportive Services individual providers in California.
See template
See template
Highland Rim Head Start Educational Leave Request Form
PDF template
A form for employees to request educational leave, specifying hours and dates for pursuing further education.
See template
See template
Travel Expense Reimbursement Form
PDF template
A form for documenting and calculating travel-related expenses for an employee attending a professional conference.
See template
See template
Virginia Ryan White Part B Formulary Supportive Documentation Form
PDF template
A form used to document medication details for reimbursement and tracking purposes in the Ryan White Part B program.
See template
See template
Jansen Volunteer Application Form
PDF template
A comprehensive application form for individuals interested in becoming volunteers with Jansen Hospice and Palliative Care program.
See template
See template
University Of Nebraska Multiple Direct Deposit Form
PDF template
Form for employees to set up or modify direct deposit payroll information across multiple financial institutions.
See template
See template
Title 200 Application Form
PDF template
Application form for reimbursement of petroleum release remediation costs by the Nebraska Department of Environment and Energy (NDEE)
See template
See template
STATE EMPLOYEE TUITION FEE WAIVER FORM
PDF template
A form for state employees to request tuition fee waiver for up to six credit hours at a state university
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for submitting vision care reimbursement claims for out-of-network services and eyewear expenses
See template
See template
Employee Benefits Administration Guide
PDF template
Comprehensive guide for managing employee benefits, enrollment, and coverage processes for CHP (likely a health provider)
See template
See template
SC 200.500 Department Procurement Cards
PDF template
Provides guidance on procurement card acquisition, usage, monitoring, and approval while mitigating financial risks in university purchasing activities.
See template
See template
LWC WC 1008
PDF template
A form for filing a workers' compensation dispute with the Louisiana Office of Workers' Compensation.
See template
See template
Complaint Resolution Form
PDF template
A form for employees or students to report and document workplace or campus complaints with space for detailed incident description and resolution.
See template
See template
ECS Standard Travel Form
PDF template
A travel expense reimbursement document for consultants detailing travel expenses, mileage, and related costs for official business travel.
See template
See template
LGPC Bulletin 101
PDF template
Monthly bulletin providing updates on local government pension schemes, regulations, and guidance for April 2013.
See template
See template
Prescription Drug Reimbursement Form
PDF template
A form for members to request reimbursement for prescription medication expenses through their health plan.
See template
See template
Expense Reimbursement Policy
PDF template
Policy detailing conditions and guidelines for reimbursing individuals for expenses related to Arizona Swimming business and programs.
See template
See template
MetLife Disability Insurance Absence Reporting Guide
PDF template
Comprehensive guide for reporting disability and medical leave claims through MetLife, including FMLA and other absence types.
See template
See template
Accident Incident Report
PDF template
A detailed form for documenting workplace accidents or incidents involving employees at Randolph College.
See template
See template
Request For Re Issued 1095 C
PDF template
Form for employees of Auburn University to request a reprint or correction of their Employer-Provided Health Insurance Offer and Coverage Form (1095-C).
See template
See template
TIM Administrator Access Request Form
PDF template
Form for requesting or modifying TIM administrator access at the University of North Carolina at Chapel Hill
See template
See template
Billing Procedures For Iowa Medicaid
PDF template
Guidelines for submitting billing forms to Iowa Medicaid for service reimbursement.
See template
See template
Productivity Enhancement Program Nomination Form
PDF template
A state government form for nominating employees for productivity and performance incentive awards based on workplace improvements.
See template
See template
Personal Automobile Reimbursement Request
PDF template
Form for employees to request reimbursement for personal vehicle use during business activities.
See template
See template
Paid Leave Request Form
PDF template
A comprehensive form for Department of Corrections employees to request various types of paid leave including sick, enforced, organizational, military, and personal time off.
See template
See template
Personal Cell Phone Reimbursement Request 1305
PDF template
A form for requesting reimbursement for personal cell phone usage by employees.
See template
See template
1106.1.1f Direct Payroll Deposit Authorization Form For All SHRA Employees (Permanent, Temporary,
PDF template
A form for University of North Carolina at Chapel Hill employees to authorize direct deposit of payroll earnings to a bank account.
See template
See template
HOUSING AGENCY RETIREMENT TRUST ENROLLMENT FORM 110
PDF template
A mandatory enrollment form for newly-eligible employees joining a housing agency retirement trust plan
See template
See template
Navajo Nation Employee Travel Policy And Procedures Handbook
PDF template
Guidelines for travel procedures and authorization for Office of Legislative Services employees within the Navajo Nation.
See template
See template
HOURLY TIME OFF REQUEST FORM
PDF template
A form for employees to request sick or vacation hours, requiring manager approval in advance.
See template
See template
Catastrophic Disability Preliminary Report
PDF template
A detailed report examining policy, eligibility, and benefits for catastrophic disability for law enforcement and fire fighters in Washington State.
See template
See template
Medical Claim Form
PDF template
A form used to request payment for eligible healthcare services already received from UnitedHealthcare.
See template
See template
HSA Payroll Deduction Authorization Form
PDF template
Form for employees to authorize payroll deductions for health savings account (HSA) contributions through the city's high-deductible health plan.
See template
See template
Record Of Employee Interview
PDF template
A standardized form for documenting interviews with construction workers to verify labor standards compliance and payroll reporting accuracy.
See template
See template
Expense Reimbursements (Travel, Seminars, Conferences, Miscellaneous Expenditures)
PDF template
Policy detailing procedures for reimbursing employees and board members for travel, conference, and training expenses in compliance with IRS regulations.
See template
See template
EMPLOYEE PERFORMANCE REVIEW FORM NON EXEMPT HOURLY
PDF template
A comprehensive evaluation form for assessing an employee's job performance, skills, productivity, and potential areas of improvement.
See template
See template
Form 207A Terminating Employee Checklist Form
PDF template
A comprehensive checklist for managing the process of an employee's departure from Pennsylvania Institute of Technology, covering hardware, access, and property return.
See template
See template
EMPLOYEE PERSONAL PROPERTY DECLARATION FORM
PDF template
Form for employees to declare personal property used at work and outline claim procedures in case of loss or damage
See template
See template
Service Agreement
PDF template
A service agreement between Janus Associates (BHS) and Park Hill School District for providing Employee Assistance Program (EAP) and workplace services to employees and their household members.
See template
See template
Offer Of Sales Employment Letter
PDF template
A formal employment offer letter for a sales position detailing salary, benefits, and employment terms.
See template
See template
ACCIDENT INCIDENT REPORT FORM
PDF template
A comprehensive form for documenting workplace accidents, injuries, or incidents involving employees, members, or visitors.
See template
See template
Dental And Eye Care Insurance Enrollment Form
PDF template
A comprehensive form for enrolling in dental and eye care insurance coverage, capturing employee and dependent information.
See template
See template
Disability Benefits Chapter
PDF template
Comprehensive guide to disability benefits types, service credit, employment restrictions, and medical certification requirements for members.
See template
See template
Chapter Twelve Disability Benefits
PDF template
Comprehensive overview of disability benefits, types of coverage, service credit, employment restrictions, and medical certification requirements for members.
See template
See template
Life Insurance Enrollment Form
PDF template
A form for employees to enroll in or modify life insurance coverage options through the Texas A&M University System.
See template
See template
Lifeworks Services, Inc. Reimbursement Form
PDF template
A form for submitting reimbursement requests for approved expenses within a specified budget and timeframe.
See template
See template
Superintendent Employment Agreement
PDF template
Employment contract for Glenn "Max" McGee as Superintendent of Palo Alto Unified School District, specifying salary, term, and benefits.
See template
See template
Vision Group Insurance Form
PDF template
Insurance claim form for submitting vision care expenses and patient information to Standard Insurance Company.
See template
See template
Travel And Expense Guidelines For Staff And Volunteers
PDF template
Guidelines for managing travel, transportation, and expense reimbursement for Unitarian Universalist Association staff and volunteers.
See template
See template
DIRECT DEPOSIT FORM
PDF template
A form for establishing or updating direct deposit banking information for State Teachers Retirement System of Ohio benefits
See template
See template
Request For Accommodation Interactive Process Checklist
PDF template
A management tool for documenting and navigating employee accommodation requests through an interactive process
See template
See template
EMPLOYEES 14 DIGIT CANCELLATION FORM
PDF template
A form for cancelling or updating employee identification and account information in a government system, specifically for Sikkim government employees.
See template
See template
TIME OFF REQUEST FORM
PDF template
A standardized form for employees to request time off with specific guidelines and authorization requirements.
See template
See template
Form 15 0005 Parking Expense Reimbursement Form
PDF template
A form for employees to request reimbursement for parking expenses when alternative parking is required due to unavailable parking at the DTC.
See template
See template
EMERGENCY CONTACT FORM
PDF template
Form for collecting employee personal contact details and emergency contact information.
See template
See template
Retiree Basic Life Insurance Form
PDF template
Form for retirees to elect or decline basic life insurance coverage and designate beneficiaries.
See template
See template
Employee Change Of Address Form
PDF template
A form for Vanderburgh County employees to update their personal contact information and address with the county auditor's office.
See template
See template
MetLife Enrollment Form
PDF template
Insurance enrollment form for employees to request coverage through their employer's group insurance plan.
See template
See template
ELITE CHOICE RETIREMENT PROGRAM 403(B) PLANS TRUSOURCE NEW ACCOUNT PACKAGE
PDF template
A comprehensive new account package for establishing a 403(b) retirement plan with Union Bank of California's TruSource division, designed for educational institutions.
See template
See template
Time Leave Benefits And Other Benefits For College Assistants
PDF template
Comprehensive document outlining leave, holiday, and fringe benefits for hourly college assistants at Brooklyn College.
See template
See template
Vanderburgh County Authorization Form
PDF template
A form for granting computer system and software application access for county employees in Vanderburgh County
See template
See template
Monthly Professional Expense Reimbursement Form
PDF template
Form for physicians to submit monthly professional expenses for reimbursement, including travel, dues, and other business-related costs.
See template
See template
Exceptional MDI Submission Form
PDF template
An internal form for employees to document and report minor defect improvements (MDIs) with potential safety and cost-saving implications.
See template
See template
Vanderburgh County Authorization Form
PDF template
A form for granting and managing employee access to county computer systems and software applications like MUNIS and Xsoft Tax.
See template
See template
Blue Cross Of Idaho Care Plus, Inc. Health Assessment
PDF template
Form for collecting health information from newly enrolled Medicare Advantage members to develop individual care plans.
See template
See template
Family And Medical Leave Act (FMLA) Employee Request Form
PDF template
A form for employees to request leave under the Family and Medical Leave Act, covering personal or family medical situations.
See template
See template
Claim Form
PDF template
Comprehensive form for submitting flexible spending account (FSA) and health reimbursement claims with multiple benefit code options.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider, detailing member information and pharmacy details.
See template
See template
Federal Income Tax Withholding For STRS Ohio Benefits
PDF template
A form for STRS Ohio benefit recipients to manage federal income tax withholding for their retirement benefits.
See template
See template
Company Reimbursement Form
PDF template
Form for students to report employer financial assistance and support for educational expenses at the University of Florida.
See template
See template
1718 FORM Travel
PDF template
A form for submitting and documenting travel expenses for reimbursement by an organization.
See template
See template
17 18 GME Funds Transfer Request Form
PDF template
A form for requesting reimbursement for medical licensing and examination expenses for graduate medical education trainees.
See template
See template
Timesheet CorrectionAdjustment Form
PDF template
A form for employees to document and request corrections or adjustments to their timesheet entries.
See template
See template
Form 1751a Benefits Enrollment
PDF template
A form for employees to enroll or modify health and welfare benefits at Los Alamos National Laboratory.
See template
See template
Expense Reimbursement Form
PDF template
A form for employees to document and request reimbursement for travel-related expenses including mileage, transportation, per diem, and miscellaneous expenses.
See template
See template
Member Information And Beneficiary Designation (MIBD) Form Instructions
PDF template
Instructions for completing the Teachers' Retirement System member information and beneficiary designation form for new and existing teachers in Illinois.
See template
See template
Time Off Request Form
PDF template
A form for employees to request various types of leave and obtain management approval for time away from work.
See template
See template
In District Hotel Approval Form
PDF template
A form for employees of District 2 Public Health to request and receive approval for in-district overnight hotel stays.
See template
See template
Worker Travel Expense Form
PDF template
Instructions for workers to claim travel expenses related to medical appointments for workplace injuries or illnesses.
See template
See template
Record Of Employee Interview
PDF template
Confidential document for recording details of employee interviews related to labor standards compliance in construction projects.
See template
See template
Union Benefits Cancellation Form
PDF template
Form for union members to cancel or modify their existing insurance and benefits coverage across multiple carriers.
See template
See template
Employee Enrollment Form
PDF template
A comprehensive form for employees to enroll in health insurance coverage with options for individual and family plans.
See template
See template
Form 8.9 Club Check Request Form
PDF template
A financial form used by 4-H clubs to request and document check issuance for club expenses with receipt requirements.
See template
See template
Advisory Opinion Letter Labor Management Services Administration
PDF template
Official Department of Labor opinion regarding whether a multi-purpose payroll deduction arrangement for IRA contributions qualifies as an employee pension benefit plan under ERISA.
See template
See template
Union Benefits Cancellation Form
PDF template
A form for union members to cancel various insurance and supplemental benefits from multiple carriers
See template
See template
Group Disability Claim Filing Instructions
PDF template
Instructions and form for filing a disability claim with American Fidelity Assurance Company for disability benefits.
See template
See template
CODE OF STATE REGULATIONS Travel Regulations
PDF template
Official guidelines for state employees and officials concerning travel expenses and reimbursement procedures for official state business.
See template
See template
Emergency Contact Form
PDF template
A form for collecting employee personal information and emergency contact details for workplace safety and communication purposes.
See template
See template
Diocese Of Owensboro Employee Exit Checklist
PDF template
A comprehensive guide for managing an employee's departure process, including property return, benefits transition, and administrative steps.
See template
See template
Short Term Disability Claim Form
PDF template
A comprehensive form for filing a short-term disability claim, capturing personal, medical, and employment details for disability benefits.
See template
See template
Tender For Procurement Of Adobe Acrobat Pro DC And Adobe Creative Cloud
PDF template
Tender document by Bank of Baroda for purchasing Adobe Acrobat Pro DC and Adobe Creative Cloud licenses for their Information Technology Department.
See template
See template
Time Off Request Form
PDF template
A formal document for employees to request and document various types of leave or time off from work.
See template
See template
Retirement Benefit Plans Summary
PDF template
A comprehensive summary of retirement plan options for regular, part-time city employees, including mandatory and voluntary retirement savings plans.
See template
See template
Retirement Benefit Plans Summary For Regular, Part Time General Schedule Employees (Non Public Safet
PDF template
A comprehensive guide detailing retirement plan options for regular, part-time general schedule employees of the City of Alexandria.
See template
See template
HUD 20000 A Submission Form
PDF template
A form for U.S. Department of Housing and Urban Development employees to submit innovative ideas for potential adoption and potential awards.
See template
See template
Retirement Checklist For 2001 Tier 1 Members
PDF template
A comprehensive checklist for employees planning retirement, outlining key steps and timelines for preparing to retire.
See template
See template
2003 W 4 EmployeeS Withholding Form
PDF template
Memo providing guidance on completing the 2003 Federal W-4 tax withholding form for employees and new hires.
See template
See template
Update To Fiscal Policy Procedures Manual
PDF template
Memorandum providing update to fiscal policy manual regarding in-state travel expense reimbursement procedures for state employees.
See template
See template
The ARAG Legal Plan
PDF template
Comprehensive legal plan booklet detailing benefits, eligibility, and services for University of California employees and retirees.
See template
See template
City Of New Orleans Spending Freeze Purchase Form
PDF template
A form for documenting and obtaining approval for non-emergency purchases during a city spending freeze.
See template
See template
WSU Faculty Computer Purchase Exemption Petition
PDF template
Process for Wright State University faculty to request computer equipment that differs from standard university recommendations.
See template
See template
Senate Bill No. 677 (Substitute)
PDF template
A legislative bill amending sections of Michigan's Natural Resources and Environmental Protection Act related to a temporary reimbursement program.
See template
See template
Payroll Bulletin
PDF template
Periodic guidance bulletin for Commonwealth payroll operations covering FBMC Focus Group meeting and I9 form updates.
See template
See template
The ARAG Legal Plan
PDF template
A comprehensive legal insurance plan document detailing benefits, eligibility, and services for University of California employees and retirees.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for requesting reimbursement for vision care services from providers outside the Davis Vision network.
See template
See template
School Capital Request Form (PA 097 0474 Requirement)
PDF template
Web-based form for self-assessment and capital request to comply with Public Act 097-0474 requirements for school facilities.
See template
See template
Travel And Other Business Expense Report
PDF template
A comprehensive form for documenting and obtaining reimbursement for travel and business expenses incurred by HHMI employees and other travelers.
See template
See template
Traveler Expense Reimbursement Form
PDF template
A form for documenting travel expenses, reimbursements, and account distribution for Howard Hughes Medical Institute (HHMI) travelers.
See template
See template
Travel Expense Reimbursement Form
PDF template
Form for submitting travel expenses and reimbursement details for Howard Hughes Medical Institute employees and non-employees
See template
See template
Tuition Reimbursement 2016 Guidelines, Instructions Application
PDF template
A financial assistance program for County employees to support their educational development and enhance job skills and opportunities.
See template
See template
Arizona State Cowbelles, Inc. Expense Report
PDF template
Form for submitting travel and business expenses for reimbursement by Arizona State Cowbelles, Inc.
See template
See template
St. MaryS University Leave Request
PDF template
A form for employees to request various types of leave from St. Mary's University, including documenting leave details and obtaining necessary signatures.
See template
See template
Employee Parking At Messiah College Frequently Asked Questions
PDF template
Comprehensive guide addressing parking regulations and procedures for Messiah College employees, including lot assignments, vehicle registration, and handling parking situations.
See template
See template
Referral Form
PDF template
A comprehensive form for collecting patient information and medical details for hospice or palliative care referral.
See template
See template
Safety Training Attendance Form
PDF template
A document for tracking participant attendance, details, and hours for safety training sessions.
See template
See template
Food Expense Approval Form
PDF template
A form for documenting and approving food expenses and event details for UW-L activities and receptions.
See template
See template
Payroll Deduction Authorization Form
PDF template
A form allowing employees to authorize, change, or stop biweekly payroll deductions for university foundation donations.
See template
See template
Expense Reimbursement Form
PDF template
A form for submitting and requesting reimbursement for travel-related expenses for an ALI conference or meeting.
See template
See template
Performance Feedback Form Values Assessment Checklist
PDF template
A structured checklist for evaluating employee performance and alignment with organizational values
See template
See template
KENMORE MIDDLE SCHOOL FITNESS CLOTHES PURCHASE FORM
PDF template
A form for Kenmore Middle School students to purchase physical education clothing and accessories.
See template
See template
Payroll Direct Deposit Form
PDF template
A form for University of British Columbia employees to provide bank account details for payroll direct deposit.
See template
See template
Summary Of The Pension Plan For Lay Employees
PDF template
Comprehensive overview of the pension benefits for lay employees of the Archdiocese of Galveston-Houston, explaining retirement eligibility and benefits.
See template
See template
Grossmont College 2019 2020 Catalog Addendum
PDF template
Comprehensive guide for veterans seeking educational benefits and support services at Grossmont College.
See template
See template
Request For Reimbursement Form
PDF template
A form for requesting financial reimbursement from the Villa Trust Account with details about the purchase and recipient.
See template
See template
Second Domiciled Adult Affidavit Of Eligibility
PDF template
A form for employees to declare a second domiciled adult for benefits eligibility at DePaul University
See template
See template
2019 2020 Short Term Disability Information
PDF template
Policy detailing disability income benefits and eligibility for Yavapai College employees, including benefit calculation and claim process.
See template
See template
Manual Tuition Waiver Request Form
PDF template
Form for requesting tuition waivers for retired employees, dependents, and special arrangements at DePaul University.
See template
See template
CLAIM FOR INDEBTEDNESS OF STATE OF WASHINGTON TO DECEASED EMPLOYEE MULTIPLE CHILDREN
PDF template
An affidavit form for children of a deceased state employee to claim wages or reimbursements owed to their parent.
See template
See template
ATSG FitBit Activity Tracker Program Purchase Form
PDF template
Form for employees to purchase FitBit activity trackers through corporate wellness program with payroll deduction options.
See template
See template
Volunteer Time Off Policy
PDF template
A policy outlining guidelines for employees to take paid time off for volunteering with nonprofit organizations, with specific eligibility and usage rules.
See template
See template
Paid Parental Leave (PPL) Request Form
PDF template
A comprehensive form for federal employees to request paid parental leave for birth, adoption, or foster care placement.
See template
See template
Paid Parental Leave (PPL) Request Form
PDF template
A comprehensive form for federal employees to request paid parental leave for birth, adoption, or foster care placement.
See template
See template
The ARAG Legal Insurance Plan
PDF template
A comprehensive legal insurance plan booklet detailing benefits, eligibility, and services for University of California employees and retirees.
See template
See template
2020 Employee Authorization For Payroll Deduction To HSA
PDF template
Form for employees to start, change, or stop payroll deductions for Health Savings Account (HSA) contributions.
See template
See template
Medical Reimbursement Claim Form
PDF template
Form for employees to submit medical, dependent care, and other eligible healthcare expenses for reimbursement through employer benefit plans.
See template
See template
NOW Reimbursement Guidelines
PDF template
Guidelines for meal and lodging reimbursement for board members during meetings, detailing daily allowances and specific conditions.
See template
See template
NEW YORK STATE COVID 19 PAID LEAVE REQUEST FORM
PDF template
Form for employees to request paid leave due to COVID-19 quarantine or isolation orders in New York State.
See template
See template
Board Member Travel Policies, Procedures, And Per Diem
PDF template
Comprehensive policy outlining travel approval, reimbursement, and per diem regulations for board members.
See template
See template
TOWN OF WILTON TIME OFF REQUEST FORM
PDF template
A form for employees to request time off from work, specifying type of leave and dates.
See template
See template
Incident Report
PDF template
A form used to document workplace incidents, accidents, illnesses, or exposures for the University of New Mexico-Taos.
See template
See template
How To Arrange And Pay For Interview Candidate Travel
PDF template
Guidelines for arranging and paying travel expenses for job interview candidates at the University of Wisconsin.
See template
See template
Application For Identification Card
PDF template
Official form for obtaining identification cards to access CBP security areas for employees involved in importing and handling merchandise.
See template
See template
POGS Sickness Benefit Application Form
PDF template
Application form for members of the Philippine Obstetrical and Gynecological Society to claim sickness benefits
See template
See template
AU Direct Deposit Authorization 2019
PDF template
A form for employees to authorize automatic deposit of payroll funds into one or two bank accounts at Antioch University.
See template
See template
POLICY 2021 EXPENSES AND REIMBURSEMENTS
PDF template
Policy outlining expense allowances and reimbursement guidelines for school personnel and board members.
See template
See template
Student Organization Request For Reimbursement
PDF template
A form for student organizations to request reimbursement up to $200 for parade decoration expenses.
See template
See template
IN LIEU OF INVOICE FORM
PDF template
A form used to request payment when standard invoice documentation is not available, designed for creating a Payment Request in B2P system.
See template
See template
Ardelle Associates Leave Request Form
PDF template
A form for employees to request Paid Time Off (PTO) or Sick Leave with supervisor approval requirements.
See template
See template
IN LIEU OF INVOICE FORM
PDF template
A form used to document payments when standard invoice documentation is not available, primarily for Harvard University administrative purposes.
See template
See template
Warranty Claim Form
PDF template
A form for customers to submit warranty claims for agricultural products or equipment with detailed failure and product information.
See template
See template
Young Lawyers Division Reimbursement Request Form
PDF template
A form for Florida Bar Young Lawyers Division members to request reimbursement for meeting-related expenses, with a maximum limit of $750.00.
See template
See template
Food Charges On The Procurement Card
PDF template
Guidelines for purchasing food using a procurement card with specific restrictions and requirements for business-related food expenses.
See template
See template
Agreement Between The Cos County Commissioners And Cos County Corrections Chapter 53 State Employees
PDF template
Collective bargaining agreement detailing employment terms, benefits, and rights for Cos County Corrections employees represented by SEIU Local 1984.
See template
See template
Claim Form
PDF template
A comprehensive claim form for medical reimbursement from GlobeMed Qatar/SEIB insurance network covering various healthcare services.
See template
See template
Travel Form Instructions
PDF template
Comprehensive instructions for district employees on completing travel forms, obtaining approvals, and reimbursement procedures for business travel.
See template
See template
Manchester Employees Contributory Retirement System Additional Contribution Calculation Request
PDF template
A form for Manchester employees to request calculation of additional retirement contributions and explore retirement benefit options
See template
See template
POGS MAP Sickness Benefit Application Form
PDF template
A form for members of the Philippine Obstetrical and Gynecological Society to apply for sickness benefits for medical and COVID-related conditions.
See template
See template
EMPLOYEE AUTHORIZATION AGREEMENT FOR DIRECT DEPOSIT
PDF template
A document allowing employees to authorize direct deposit of wages and provide banking details for payroll processing.
See template
See template
University Of Michigan Prescription Drug Plan Guide
PDF template
Comprehensive guide for managing prescription drug benefits through Magellan Rx Management for University of Michigan employees and members.
See template
See template
Expense Report Form (Request For Reimbursement Of Team Oregon Fee)
PDF template
A form for requesting reimbursement for Team Oregon motorcycle training class expenses by A.B.A.T.E. of Oregon members.
See template
See template
Rent Reimbursement Application
PDF template
A state-level application for rent reimbursement for eligible Iowa residents aged 65+ or disabled individuals with low household income.
See template
See template
City Of Kenosha Health Savings Account (HSA) Payroll Deduction Form
PDF template
Form for City of Kenosha employees to set up or modify Health Savings Account payroll deductions through Johnson Bank.
See template
See template
Long Term Disability Claim Form Statement Of Employee
PDF template
A comprehensive form for employees to file a long-term disability claim with Lincoln Financial Group, detailing personal, employment, and medical information.
See template
See template
Burton Elementary School PTA Check Requisition Form
PDF template
A form used by Burton Elementary School PTA members to request reimbursement or payment for school-related expenses and events.
See template
See template
EXPENSE REIMBURSEMENT FORM
PDF template
A form for submitting travel and business-related expense reimbursements with detailed categories for meals, hotel, mileage, airfare, and miscellaneous expenses.
See template
See template
Employee Timesheet
PDF template
A timesheet document for tracking employee work hours and certifying time worked for staffing and payroll purposes.
See template
See template
Sidewalk Liability Mitigation Expense Reimbursement Form
PDF template
A form for member cities to request reimbursement for sidewalk-related mitigation expenses up to $1,000 per fiscal year.
See template
See template
Health Safety Training Reimbursement Request
PDF template
A form for child care providers to request partial reimbursement for health and safety training courses in select California cities.
See template
See template
O.Henry Middle School PTA Check Request Form
PDF template
A form for PTA members and staff to request reimbursement or disbursement of expenses through the O.Henry Middle School PTA.
See template
See template
Core Trainings Registration And Reimbursement Form
PDF template
Form for registering and requesting reimbursement for professional training programs for Education Minnesota members.
See template
See template
Manchester Employees Contributory Retirement System Additional Contribution Calculation Request
PDF template
A form allowing employees to request calculation of additional retirement contributions with specific authorization and salary assumptions.
See template
See template
Flexible Spending Account (FSA) Enrollment Form
PDF template
A form for employees to elect and contribute to Flexible Spending Accounts for health care and dependent care expenses
See template
See template
Flexible Spending Account Reimbursement Form
PDF template
A form for submitting out-of-pocket healthcare expenses for reimbursement through a Flexible Spending Account (FSA)
See template
See template
Flexible Spending Account Agreement Form
PDF template
A form for employees to elect and set up Flexible Spending Accounts for healthcare and dependent care expenses.
See template
See template
Fulton County Government Authorization For Payroll DeductionHealth Savings Account Contribution
PDF template
A form for Fulton County employees to authorize health savings account (HSA) contributions through payroll deductions for the 2023 plan year.
See template
See template
2023 HSA Voluntary Salary Reduction Form
PDF template
Form for employees to start, change, or cancel pre-tax contributions to a Health Savings Account (HSA) through payroll deduction
See template
See template
ICS 213 General Message
PDF template
A form for documenting and approving lodging, per diem, and fuel expenses for emergency resources under CFAA mobilization.
See template
See template
SupervisorS Incident Investigation Form
PDF template
A two-part form for documenting workplace incidents and potential worker injuries for the NEWESD 101 Workers' Compensation Cooperative.
See template
See template
Dependent Cancellation Form
PDF template
A form for participants to cancel or modify dependent health insurance coverage under the Local Government Health Insurance Program.
See template
See template
Form LG03 Local Government Health Insurance Program Cancellation Form
PDF template
A form for cancelling local government health insurance coverage with multiple termination reason options
See template
See template
American Accounting Association Travel And Business Expense Report Form 2023
PDF template
Form for reporting and requesting reimbursement of business travel expenses for non-employees of the American Accounting Association.
See template
See template
New Hire Active Employee Enrollment Form
PDF template
A comprehensive form for new employees to enroll in health, dental, vision, and life insurance benefits with Fulton County, Georgia.
See template
See template
Proof Of Age Or Disability Application
PDF template
Application for senior citizens or disabled individuals seeking reimbursement, requiring proof of age and residency status for 2022 and 2023.
See template
See template
Nomination Form Leonard W. Sandridge Outstanding Contribution Award
PDF template
A form for nominating an individual for the Leonard W. Sandridge Outstanding Contribution Award within an organization.
See template
See template
2023 Pumpout Operations Maintenance Grant Worksheet
PDF template
A grant worksheet for marina operators to document pumpout operations expenses and request reimbursement from the Maryland Department of Natural Resources.
See template
See template
AGU Reimbursement Form
PDF template
A form for submitting travel-related expenses for reimbursement by the American Geophysical Union (AGU)
See template
See template
EXPENSE REIMBURSEMENT FORM
PDF template
A form for submitting travel and business-related expense reimbursements, including meals, hotel, mileage, airfare, and miscellaneous expenses.
See template
See template
2024 2025 Benefits Enrollment Form
PDF template
Form for employees to select health benefit plans, add or remove dependents, and update personal information for the upcoming benefits year.
See template
See template
Group Medical Plan Waiver Form
PDF template
A form for employees to waive medical plan coverage by certifying alternative health insurance coverage and understanding ACA requirements.
See template
See template
O.Henry Middle School PTA Check Request Form
PDF template
A form for submitting expense reimbursement or disbursement requests for O.Henry Middle School PTA staff and parents
See template
See template
Student Accounts Company Reimbursement Form
PDF template
A form for students to document employer tuition reimbursement and defer university payment accordingly.
See template
See template
2024 Pastoral Agreement Form (PAF)
PDF template
A comprehensive form detailing compensation, benefits, and service terms for pastoral staff in the Eastern Regional Conference of Churches of God.
See template
See template
Payroll Deduct Roth IRA Contribution Form
PDF template
A form for employees to authorize automatic Roth IRA contributions from their paycheck, with special provisions for age 50 and over.
See template
See template
DIRECT DEPOSIT CANCELLATION FORM
PDF template
Form for canceling direct deposit of retirement benefit payments for Hanford Employee Welfare Trust retirees.
See template
See template
Montana DNRC Fire Meal Authorization Form Instructions
PDF template
Instructions for documenting and authorizing fire-related meal purchases by Montana Department of Natural Resources and Conservation employees.
See template
See template
FULL TIME DOMESTIC PARTNERSHIP AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR HEALTH INSURANCE EFFECTIVE Y
PDF template
Authorization form for employees to select health insurance coverage options and allow payroll deductions for Essex County health insurance plans
See template
See template
FULL TIME AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR HEALTH INSURANCE EFFECTIVE YEAR 2024
PDF template
A form for employees to authorize payroll deductions for health insurance coverage with Essex County for the year 2024.
See template
See template
2024 Guardian Dental Cancellation Form
PDF template
A form to request cancellation of Guardian Dental insurance coverage by an employee.
See template
See template
2024 Health Insurance Buy Out Program Enrollment Form
PDF template
An enrollment form for employees to opt out of RFMH health insurance and receive an annual cash payment by meeting specific eligibility requirements.
See template
See template
2024 Health Insurance Waiver Form
PDF template
Form for employees to waive health insurance coverage and provide proof of alternative coverage under Affordable Care Act regulations.
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
Form for state and local government employees to authorize HSA payroll contributions and select health plan details.
See template
See template
HSA Payroll Deduction Form 2024
PDF template
A form for employees to authorize payroll deductions for Health Savings Account contributions with IRS contribution limits and University contribution details.
See template
See template
2024 Direct Member Reimbursement Request Form
PDF template
A form for Medicare plan members to request reimbursement for dental, eyewear, and hearing aid services.
See template
See template
PLAN YEAR 2024 ENROLLMENTCHANGE FORM MEDICAL SPENDING CONVERSION (MSC) HEALTH BENEFITS BUY OUT WAIVE
PDF template
Enrollment form for New York City employees to participate in or terminate health benefits buy-out waiver program for plan year 2024.
See template
See template
American Accounting Association Travel And Business Expense Report Form 2024
PDF template
A comprehensive form for reporting and requesting reimbursement of business travel expenses for non-employees.
See template
See template
Expense Report
PDF template
A comprehensive expense report form for travel and business-related expenses for the Society for Industrial and Applied Mathematics (SIAM).
See template
See template
PART TIME AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR HEALTH INSURANCE EFFECTIVE YEAR 2024
PDF template
A form for part-time employees to authorize health insurance premium deductions with Essex County for the 2024 benefit year.
See template
See template
MRTF Member Benefit 2024
PDF template
Comprehensive overview of membership types, benefits, and pricing for the Michigan Roof & Turf Foundation (MRTF) organization.
See template
See template
Health Insurance Biweekly Rates
PDF template
Detailed health insurance biweekly rates for different employee groups and salary levels effective January 4, 2024.
See template
See template
Health Insurance Biweekly Rates
PDF template
Biweekly health insurance rates for NYSCOPBA employees effective July 1, 2024, with rate details for different salary grades and health plans.
See template
See template
2024 City Of Bellingham Neighborhood Services Support Reimbursement Request
PDF template
A reimbursement request form for Bellingham neighborhood associations to request funding for approved projects and activities.
See template
See template
Disability Insurance Claim Packet Instructions
PDF template
Instructions for filing a disability insurance claim with Standard Insurance Company, detailing the application process and required documentation.
See template
See template
Conference RequestTravel Reimbursement Form
PDF template
Form for employees to request and document travel expenses and reimbursement for conference or training activities.
See template
See template
VADA Termination Or Voluntary Cancellation Form
PDF template
Form for employees to cancel or terminate their employment benefits including medical, dental, vision, disability, and life insurance.
See template
See template
2024 Vanderbilt Payroll Deduction Form
PDF template
A form allowing Vanderbilt University employees to purchase season tickets via payroll deduction with specific eligibility rules and conditions.
See template
See template
Benefits Cancellation Form
PDF template
Form for employees to remove dependents from their healthcare or insurance benefits plan.
See template
See template
University Of Michigan Benefits Enrollment Form
PDF template
Comprehensive guide for employees to elect University of Michigan benefits, explaining enrollment procedures and deadlines.
See template
See template
Combined Giving, Contribution Election Agreement
PDF template
A form for employees to authorize charitable contributions through payroll deductions for selected agencies.
See template
See template
Flexible Spending Accounts (FSA) Program Direct Deposit EnrollmentChangeCancellation Form
PDF template
A form for enrolling in or changing direct deposit details for Health Care Flexible Spending Account (HCFSA) and Dependent Care Assistance Program (DeCAP)
See template
See template
2024 Poulsbo Tourism Grant Awardee Process
PDF template
Guidelines for tourism grant awardees in the City of Poulsbo, detailing reporting requirements and reimbursement process for lodging tax grants.
See template
See template
Disability Insurance Claim Packet Instructions
PDF template
Comprehensive guide for applying for disability insurance benefits through Standard Insurance Company, detailing claim submission process and requirements.
See template
See template
Road Service Reimbursement Request
PDF template
Form for AAA members to request reimbursement for roadside assistance services in specific states and territories.
See template
See template
Employee HSA Payroll Deduction Form
PDF template
A form for employees to authorize payroll deductions for their Health Savings Account contributions with annual contribution limit details.
See template
See template
Board Member Compensation Expenses
PDF template
Policy governing board member expense reimbursement, travel, and compensation guidelines for South Eastern Special Education District.
See template
See template
School Board Member Compensation Expenses Policy
PDF template
Policy governing compensation, expense reimbursement, and travel expenses for school board members in North Boone Community Unit School District 200.
See template
See template
Board Member Expense Reimbursement Form
PDF template
A form for school board members to submit and document travel expenses for reimbursement
See template
See template
Board Member Estimated Expense Approval Form
PDF template
A form for school board members to request pre-approval of travel expenses and reimbursements for district-related or grant-related activities.
See template
See template
Board Member Estimated Expense Approval Form
PDF template
A form for school board members to request and document travel expense reimbursements and approvals.
See template
See template
School Board Exhibit Resolution To Regulate Expense Reimbursements
PDF template
A resolution establishing guidelines for travel, meal, and lodging expense reimbursements for school board members and district staff.
See template
See template
Board Member Compensation Expenses
PDF template
Policy governing expense reimbursement and compensation for school board members, including restrictions and approval processes.
See template
See template
Board Member Compensation Expenses Policy
PDF template
Policy governing compensation, expense reimbursement, and financial guidelines for school board members in Geneseo Community Unit School District 228.
See template
See template
2125 Board Member Compensation Expenses
PDF template
Policy governing compensation, reimbursement, and expense guidelines for school board members.
See template
See template
Benefits Administration Letter 21 303
PDF template
Guidelines for federal agencies seeking reimbursement for emergency paid leave under the American Rescue Plan Act of 2021.
See template
See template
U.S. Retailer Coupon Invoice Form
PDF template
A form for retailers to submit and track coupon redemptions with detailed tracking and payment information.
See template
See template
MyFitRx And Kids On The Move Reimbursement Form
PDF template
A reimbursement form for members participating in MyFitRx or Kids on the Move fitness programs, offering up to $50 per benefit year.
See template
See template
East Indiana AHEC Clinical Student Travel Form 22 23
PDF template
A form for students to document and track clinical rotation travel details for potential reimbursement.
See template
See template
Hanford Employee Welfare Trust Short And Long Term Disability Plan And Disability Equalizer Benefit
PDF template
Summary plan description detailing short and long term disability benefits for Hanford employees
See template
See template
Progressive Discipline Action Form
PDF template
A structured document for documenting employee performance issues, corrective actions, and disciplinary consequences.
See template
See template
City Council Policy 2 2 Travel And Conferences
PDF template
Policy governing travel and conference reimbursements for city elected officials and staff, outlining approval processes and guidelines for in-state and out-of-state travel.
See template
See template
Exemption Of HotelMotel Tax When Traveling On Official Business
PDF template
Guidelines for federal employees regarding hotel and motel tax exemptions during official travel.
See template
See template
Graduate Student Organization Cultural Application
PDF template
Application for graduate students to get reimbursed for cultural and artistic event expenses up to $300 per fiscal year.
See template
See template
LEAVE REQUEST FORM
PDF template
A form for employees to request various types of leave from work, including documentation of absence type, duration, and required approvals.
See template
See template
Proof Of Age Or Disability Application
PDF template
Application for age or disability-based reimbursement with detailed eligibility requirements for tax years 2022 and 2023.
See template
See template
Retiree Benefits Enrollment Form
PDF template
Form for retirees or surviving spouses to enroll or modify health and dental benefits coverage options.
See template
See template
Travel Expense Report Form (ER)
PDF template
A form for documenting and submitting travel-related expenses for reimbursement, including conference costs, transportation, and miscellaneous expenses.
See template
See template
Invoice Check List
PDF template
A comprehensive checklist for submitting grant reimbursement documentation with detailed requirements for different expense categories.
See template
See template
Use Of PCC Van (OP P 262)
PDF template
Establishes criteria and process for reservation and use of PCC vans by authorized employees for official college activities.
See template
See template
Corporate Personal Pension Employee Application Form
PDF template
An employee application form for a corporate personal pension plan with Professional Provident Society Investments.
See template
See template
Change Of Address Form For Housing Benefit And Council Tax Benefit
PDF template
A form for updating residential address details for housing and council tax benefit purposes by Bridgend County Borough Council.
See template
See template
Hazard Mitigation Programs Reimbursement Form
PDF template
A form for documenting and requesting reimbursement for hazard mitigation project costs and expenses.
See template
See template
Claim Process For Swasthya Ratna Policy
PDF template
Detailed guide explaining cashless and reimbursement claim processes for insurance policy, covering planned and emergency hospitalizations.
See template
See template
APPENDIX A Policy On Travel And Expense Reimbursement
PDF template
Policy detailing guidelines for travel expenses, reimbursement, and authorized expenditures for Pajaro Valley Water Management Agency officials and employees.
See template
See template
CLAIM FORM FOR HEALTH DEPENDENT CARE EXPENSES
PDF template
A form for employees to request reimbursement for health and dependent care expenses through their Flexible Spending Account (FSA)
See template
See template
Flexible Spending Account Enrollment Form
PDF template
A form for employees to enroll in flexible spending account benefits and set up direct deposit for reimbursements.
See template
See template
Initial Interview Form
PDF template
A comprehensive form for veterans or their family members to collect information needed to apply for veterans' benefits.
See template
See template
Enrollment Form
PDF template
An enrollment form for collecting personal and dependent information for insurance or benefits enrollment with Lincoln Financial Group.
See template
See template
Sick Leave Pool Contribution Form
PDF template
A form allowing employees to voluntarily donate sick leave hours to a shared organizational sick leave pool.
See template
See template
Direct DepositInformation And Instructions
PDF template
A form for setting up electronic payments from Wespath Benefits and Investments for retirement distributions and protection plan payments.
See template
See template
Request For Payments To Trust TrusteeS Acknowledgment
PDF template
A form for directing State Employees' Retirement System benefit payments to a trust for a minor or legally disabled individual.
See template
See template
303 Employee Compensation And Leave Time
PDF template
A policy outlining paid time off procedures, compensation, and leave time guidelines for full-time salaried employees at St. George Academy.
See template
See template
3359 31 05 Travel On Behalf Of The University
PDF template
Policy governing travel procedures, expenses, and reimbursement for University of Akron employees and students during university business travel.
See template
See template
UC ANR Leave Request Form
PDF template
Form for employees to request and document a leave of absence, including details of leave type, dates, and signatures.
See template
See template
312 Form Completion Guidelines
PDF template
Guidelines for completing a 312 requisition form for purchases in the Chemistry Department's stockroom.
See template
See template
IRIS Travel Policy And Procedures
PDF template
Comprehensive guidelines and procedures for travel by IRIS employees, covering authorization, costs, transportation, lodging, and reimbursement.
See template
See template
LDSS 3151 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) CHANGE REPORT FORM
PDF template
A form for reporting changes in circumstances that may affect Supplemental Nutrition Assistance Program (SNAP) benefits.
See template
See template
UCPATH DIRECT RETRO REQUEST
PDF template
A form for processing salary expense transfers for UC employees, replacing the previous UCCE Salary Expense Transfer Request form.
See template
See template
Election For Online W 2 Delivery Form
PDF template
Form for Texas State University employees to consent to or withdraw from electronic W-2 delivery via online portal
See template
See template
Administrative Procedure 323 SEPARATION
PDF template
Procedures for nonacademic, administrative, and academic employees terminating employment with the University, including handling of benefits and exit process.
See template
See template
Employee Performance Review Form Appendix 324A
PDF template
A comprehensive form for evaluating employee performance, goals, and professional development
See template
See template
Pension Application Form
PDF template
Comprehensive application form for pension insurance covering employer and employee details for individual or group policies.
See template
See template
Performance Review
PDF template
Comprehensive guide detailing the systematic process for conducting employee performance reviews within the Unified Government organization.
See template
See template
3352 7 07 Travel
PDF template
Comprehensive policy governing travel expenses, reimbursement guidelines, and documentation requirements for university personnel
See template
See template
3.4.1p. Employee Access To Facilities
PDF template
Procedure detailing key fob and access control for employees at Ogeechee Technical College, including how access is granted and managed.
See template
See template
Form 3503 FR.03 Termination Checklist
PDF template
A comprehensive checklist for HR specialists and departments to follow when processing an employee's termination, covering administrative and equipment-related tasks.
See template
See template
Title 38 United States Code Section 3679(E) School Compliance Form
PDF template
A compliance form for educational institutions to confirm adherence to veterans' educational benefits requirements under the Veterans Benefits and Transition Act of 2018.
See template
See template
DSS Form 37113 Contribution Form
PDF template
A form used by the South Carolina Department of Social Services to document financial contributions to a household or benefit group.
See template
See template
Petitioning For Superior Court Review When You Disagree With A DSHSHCA Benefits Administrative Heari
PDF template
A step-by-step guide for individuals seeking to appeal administrative orders related to DSHS/HCA benefits through Superior Court review process.
See template
See template
Cerritos College FORMS
PDF template
Comprehensive collection of human resources forms for Cerritos College employees covering various administrative and personnel processes.
See template
See template
UNC Hurricane Matthew Special Leave Request Form
PDF template
Form for UNC employees to request paid leave due to substantial damage from Hurricane Matthew
See template
See template
TOWN OF MILLIS EMERGENCY CONTACT FORM
PDF template
A form for employees to provide personal contact information and emergency contact details for workplace safety purposes.
See template
See template
PURCHASE ORDER REQUEST FORM REIMBURSEMENT REQUEST FORM
PDF template
Official form for submitting purchase order requests and reimbursement claims for Knightsen Elementary School District
See template
See template
3 Month Probationary Review
PDF template
Policy and procedure for conducting a 3-month performance review for new employees during their 6-month probationary period.
See template
See template
WVUF Request For Payment
PDF template
A form used by West Virginia University employees to request vendor payments and document business expenses.
See template
See template
Change Of Address Request Form (For Retirees Beneficiaries)
PDF template
A form for retirees and beneficiaries to update their mailing address with the Employees' and Elected Officials' Retirement Systems.
See template
See template
The 3 RS To Retirement
PDF template
A comprehensive guide for employees planning to retire, covering the steps of retiring, resigning, and managing retiree health benefits.
See template
See template
Claim For Temporary Relocation Expenses (Residential Moves)
PDF template
A form for families and individuals to claim reimbursement for temporary relocation expenses from the U.S. Department of Housing and Urban Development.
See template
See template
Waiver Of Service Period For Retirement Plan Participation
PDF template
A form allowing employees to waive the one-year service requirement for retirement plan participation based on previous employment at eligible organizations.
See template
See template
Procedure 410 19 Employee Volunteer And Education Leave
PDF template
A policy providing full-time employees with 8 hours of annual leave for volunteer and educational activities in the community.
See template
See template
Roster Billing Form Completion Instructions
PDF template
Instructions for healthcare providers to submit reimbursement claims for H1N1 vaccine administration and treatment of uninsured individuals.
See template
See template
MIP Invoice Template
PDF template
Detailed instructions for completing and submitting quarterly invoices for grant deliverables and reimbursements.
See template
See template
Medicare Reimbursement Account (MRA) Claim Form Instructions
PDF template
Detailed instructions for submitting Medicare Part B premium reimbursement claims through a Medicare Reimbursement Account.
See template
See template
Request For Invoice Form
PDF template
A form for external customers to request invoices from the Newport-Mesa Unified School District's Fiscal Services department.
See template
See template
MCPS Form 450 2 Optional Dependent Term Life Insurance EnrollmentCancellation Form
PDF template
Form for enrolling or canceling optional dependent term life insurance for Montgomery County Public Schools employees and retirees.
See template
See template
Employee Benefit Plan Enrollment
PDF template
Montgomery County Public Schools form for new employees and those with qualifying life events to enroll in benefit plans
See template
See template
Cambria Comm Services District Enrollment And Contribution Form
PDF template
Form for employees to enroll in and contribute to the Cambria Community Services District 457 Deferred Compensation Plan at MissionSquare Retirement.
See template
See template
Direct Deposit
PDF template
Procedure for processing employee direct deposit forms, including enrollment, changes, and verification steps.
See template
See template
HealthFlex Mandatory Premium And Coverage Waiver Form
PDF template
A form for enrolled participants or new hires to decline HealthFlex health plan coverage and declare their reason for doing so.
See template
See template
Personnel Maintenance Request Form
PDF template
A form used by East Lake Tarpon Special Fire Control District to manage employee system access, including new user setup, security changes, and employee deactivation.
See template
See template
DWS ESD 475 Change Report Form
PDF template
A form for reporting changes in various state assistance programs including financial aid, Medicaid, SNAP, and child care benefits.
See template
See template
SI 2047 Your Disability Benefit Claim
PDF template
Comprehensive guide and forms for applying for disability insurance benefits, including instructions for claim submission and potential benefit reductions.
See template
See template
Out Of Network Reimbursement Form
PDF template
A form for employees to submit out-of-network healthcare service reimbursement claims with detailed patient and service information.
See template
See template
AP 3C3A(B) Claim For AbsenceTravel Reimbursement
PDF template
Guidelines and process for obtaining reimbursement for authorized travel expenses within the Kern Community College District.
See template
See template
4 H Club Individual Reimbursement Form
PDF template
Form for 4-H Club members to request reimbursement for personal expenses incurred for club activities.
See template
See template
Volume No. 1Policies Procedures TOPIC NO. 50445 Cardinal Section No. 50400Deductions
PDF template
Comprehensive policy document outlining direct deposit procedures, mandates, and administration for Virginia state employees.
See template
See template
Staff Movement Register
PDF template
A record-keeping tool for tracking staff movements, arrivals, departures, and visits within an organization
See template
See template
LDSS 5067 NYS OTDA State Supplement Program Direct Deposit Cancellation Form
PDF template
Form for cancelling direct deposit for New York State Supplement Program benefits
See template
See template
Authorization Form For RIPTA Wave Pass Payroll Deduction
PDF template
A form allowing state employees to authorize payroll deductions for purchasing Rhode Island Public Transit Authority (RIPTA) commuter passes.
See template
See template
Direct Deposit Authorization Form
PDF template
Form for authorizing direct deposit of flexible spending account (FSA) or health reimbursement account (HRA) reimbursements.
See template
See template
Performance Expectations Feedback Form
PDF template
A formal document for documenting performance deficiencies and required corrective actions for employees.
See template
See template
Minnesota State Colleges And Universities System Procedures Travel Management
PDF template
Comprehensive guidelines for travel authorization, approval, and reimbursement for employees, trustees, and students within the Minnesota State Colleges and Universities system.
See template
See template
Minnesota State Colleges And Universities System Procedures Chapter 5 Administration
PDF template
Procedures for managing special expenses and expense allowances for system employees in the Minnesota State Colleges and Universities system.
See template
See template
Arbitration Award In Dane County (Public Health) Labor Dispute
PDF template
Arbitration hearing regarding salary continuation benefits dispute between Dane County and District 1199W union
See template
See template
Employee Emergency Contact Form
PDF template
A document for collecting employee emergency contact information and personal details for workplace safety and communication purposes.
See template
See template
LEAVE REQUEST FORM
PDF template
A form for employees to request and track various types of leave including annual, sick, personal, and unpaid leave.
See template
See template
DULA Leave Request Form
PDF template
A form for employees to request various types of leave including sick, vacation, and unpaid leave at Dongguk University Los Angeles.
See template
See template
Fitness Reimbursement Request
PDF template
Form for members to request reimbursement for qualified fitness expenses through Blue Cross Blue Shield of Massachusetts.
See template
See template
Weight Loss Reimbursement Request
PDF template
A form for members to request reimbursement for qualified weight-loss program fees from Blue Cross Blue Shield of Massachusetts.
See template
See template
Leave Program Procedures
PDF template
Detailed procedures for vacation leave accrual and usage for employees at Owens Community College.
See template
See template
Petty Cash Procedure 5.5P
PDF template
Guidelines for reimbursing petty cash expenses with a maximum limit of $100 per transaction.
See template
See template
Expenses
PDF template
Policy governing travel, meal, and lodging expense reimbursement for employees of Sterling Public Schools CUSD #5.
See template
See template
Employee Estimated Expense Approval Form
PDF template
A form for employees to request approval and reimbursement for estimated travel and business expenses.
See template
See template
560 Expenses
PDF template
Policy governing employee expense reimbursement, travel costs, and advancement procedures for the Kenilworth School District.
See template
See template
Expenses Policy
PDF template
Policy defining expense reimbursement guidelines and procedures for school district employees and administrators.
See template
See template
General Personnel Expenses
PDF template
Policy governing employee expense reimbursements, advancements, and documentation requirements for official business expenses.
See template
See template
Household Report Form
PDF template
A form for reporting household information to maintain public assistance benefits in Minnesota.
See template
See template
WIGI Bill Residency Affidavit For Children And Spouses Of Eligible 5 Year Veterans
PDF template
A form for children and spouses of veterans to establish residency eligibility for Wisconsin educational benefits
See template
See template
Career Personnel Performance Review
PDF template
A comprehensive performance review document for assessing an employee's job performance, knowledge, quality, and quantity of work.
See template
See template
EMPLOYEE LEAVE REQUEST FORM
PDF template
Official state form for employees to request various types of leave from work, including vacation, sick leave, and other time-off categories.
See template
See template
Employee Time Off Request Form
PDF template
A form for employees to request time off for various reasons, subject to employer approval.
See template
See template
Shared Leave Request Form
PDF template
A form for state employees to request shared leave due to serious medical conditions or family illness.
See template
See template
Reimbursement For Expenses Procedures
PDF template
Comprehensive procedure detailing travel expense reimbursement guidelines for Northwest Educational Service District 189 employees.
See template
See template
Reimbursement For Travel Related Expenditures
PDF template
Policy outlining guidelines for travel expense reimbursement for faculty, staff, administrators, students, and non-employees traveling on behalf of the College.
See template
See template
TIME OFF REQUEST FORM
PDF template
Detailed guidelines for employees requesting time off and supervisors documenting vacation time
See template
See template
Tier 2 Retirement Checklist
PDF template
Comprehensive checklist for Tier 2 retirement application process, detailing required forms and documentation for pension and benefits
See template
See template
Travel Expenses Policy
PDF template
Policy governing travel expenses, reimbursement, and authorization for university business travel.
See template
See template
Procedure 4.4.3p. (III.M.I.) Employee Complaint Resolution
PDF template
A formal process for resolving work-related employee complaints within the Technical College System of Georgia, ensuring fair treatment and open communication.
See template
See template
Application For Group Insurance CHEIBA Trust
PDF template
A comprehensive insurance application form for employee group insurance coverage with options for various types of insurance benefits.
See template
See template
Incident Investigation Form
PDF template
A comprehensive form for documenting workplace incidents, injuries, and required follow-up actions.
See template
See template
Optional Life Insurance Enrollment Form
PDF template
Insurance enrollment form for optional life insurance coverage for employees, spouses, and children with various coverage options.
See template
See template
Employee Name Change Form
PDF template
A form for employees to update their name in university payroll and HR systems with required documentation.
See template
See template
Montana Judicial Branch Administrative Policies Judicial Branch Travel
PDF template
Policy governing travel requirements, reimbursement, and guidelines for Montana Judicial Branch officials and employees.
See template
See template
Vehicle Parking Registration
PDF template
Form for employees to register their vehicles for parking at UWSA (University of Wisconsin System Administration) location.
See template
See template
Summary Plan Description Bargained Cash Balanced Program 2 Of The ATT Pension Benefit Plan
PDF template
A comprehensive guide to benefits for employees under the Bargained Cash Balance Program #2, detailing pension plan provisions and eligibility.
See template
See template
GROUP PLANS ENROLLMENT FORM
PDF template
Comprehensive form for employees to select and enroll in group insurance and benefit plans covering life, disability, medical, and supplemental insurance options.
See template
See template
Mileage Reimbursement Procedure
PDF template
Procedure for requesting reimbursement for personal vehicle use on county business, detailing submission requirements and documentation process.
See template
See template
Security Incident Report
PDF template
Official form for documenting security incidents at the Mississippi State Department of Health's Office of Health Informatics.
See template
See template
Employer Affidavit Of Income And Benefits
PDF template
Legal document providing instructions for employers to report an employee's income, benefits, and financial records to assist court proceedings.
See template
See template
Proof Of Claim Form
PDF template
A form for filing claims against Freestone Insurance Company, which is in liquidation, with a deadline of December 31, 2015.
See template
See template
Code Book Purchase Reimbursement Form
PDF template
A form for businesses to request reimbursement for code book purchases with receipt or returned check documentation.
See template
See template
901 Accounts Deposits Reimbursements (Spending)
PDF template
Guidelines for managing 901 accounts for student organizations, including account balance checking, responsible spending, and deposit procedures.
See template
See template
Administrative Policy And Procedures Manual 901 REIMBURSABLE BUSINESS RELATED EXPENSES
PDF template
Policy outlining the Judicial Branch's guidelines for employee reimbursement of job-related expenses and travel.
See template
See template
90 Day Waiver Request Form
PDF template
Form for providers to request a 90-day waiver for claims submission to MassHealth outside standard time limits.
See template
See template
Emergency Contact Form
PDF template
A document for collecting emergency contact information for employees to ensure quick communication during urgent situations.
See template
See template
Directive 9.12 Travel
PDF template
Guidelines and procedures for Columbus Police Division personnel traveling on official city business, including reimbursement and expense policies.
See template
See template
Group Benefits EnrolmentChange Form
PDF template
A comprehensive form for enrolling or changing group benefit plan details for employees, including personal information, coverage selection, and benefit options.
See template
See template
Advancing Access Patient Information Form
PDF template
Comprehensive form for collecting patient personal information, contact preferences, and insurance details for medical services.
See template
See template
Subscriber Claim Form
PDF template
A comprehensive insurance claim form for submitting medical service reimbursements to Blue Cross Blue Shield of Massachusetts.
See template
See template
Benefits Administration Letter 99 101
PDF template
Official guidance from the Office of Personnel Management addressing common documentation problems in Federal Employees Retirement System (FERS) applications and retirement claims.
See template
See template
Conference And Travel RequestExpense Claim Form
PDF template
A comprehensive form for requesting and claiming conference and travel expenses for district employees.
See template
See template
U.S. Coast Guard Auxiliary 9CR Claim For Reimbursement Travel Form
PDF template
Official form for Coast Guard Auxiliary members to claim out-of-pocket travel expenses for reimbursement.
See template
See template
Halina Pelczar V. Board Of Review, Department Of Labor, And AE Clothing Corporation
PDF template
Judicial opinion regarding unemployment benefits appeal involving an employee's voluntary job separation
See template
See template
BOARD OF DIRECTORS AND EXECUTIVE COMMITTEE TRAVEL OTHER EXPENSE POLICY, PROCEDURES, AND LIMITATIONS
PDF template
Policy detailing travel expense reimbursement guidelines for Board of Directors and Executive Committee members of an organization.
See template
See template
BOARD OF DIRECTORS AND EXECUTIVE COMMITTEE TRAVEL OTHER EXPENSE POLICY, PROCEDURES, AND LIMITATIONS
PDF template
Policy outlining travel expense reimbursement guidelines for Board of Directors and Executive Committee members of the Academy.
See template
See template
Veterans Administration Aid And Attendance Claim Checklist
PDF template
Comprehensive checklist of required documentation for filing a Veterans Administration Aid and Attendance benefit claim, including personal, financial, and military records.
See template
See template
Purchase Card Manual
PDF template
A comprehensive manual detailing procedures, responsibilities, and guidelines for using purchase cards at Yavapai College.
See template
See template
AB13 (VACA) Affidavit For Eligible Veterans Dependents
PDF template
A document outlining tuition exemption requirements for veterans and their dependents at College of the Siskiyous under the Veterans Access, Choice, and Accountability Act.
See template
See template
Alberta Accident Benefits Initial Claims Process
PDF template
A comprehensive guide for filing insurance claims and accessing medical benefits after an automobile accident in Alberta, Canada.
See template
See template
MY BENEFIT PLAN BOOKLET
PDF template
Comprehensive benefit plan booklet providing counseling and life skills support services for plan members and their dependent children.
See template
See template
PA ABLE Savings Program Workplace Guide
PDF template
A guide for employers to help employees with disabilities save money through tax-free ABLE accounts with payroll deduction options.
See template
See template
Payroll Deduction Guide
PDF template
A comprehensive guide explaining how employees can contribute to ABLE United accounts through payroll deductions and the responsibilities of employees, employers, and the Plan.
See template
See template
Alternate Benefits Program Mandatory Contributions 401(A) Voluntary 403(B) Loan Authorizations
PDF template
Procedure for employees to request and process loans through investment providers using specific authorization steps.
See template
See template
Direct Deposit Form For NYS Employees
PDF template
Form for New York State employees to set up, modify, or cancel direct deposit bank account information for payroll.
See template
See template
Academic Affairs Personnel LEAVE REQUEST FORM
PDF template
A comprehensive form for university employees to request various types of leave with multiple approval levels.
See template
See template
Affordable Care Act (ACA) Health Insurance Payment AUTHORIZATION FOR VOLUNTARY PAYROLL DEDUCTION
PDF template
Authorization form for employees to voluntarily have health insurance premiums deducted from their paycheck under the Affordable Care Act.
See template
See template
Group Insurance Accelerated Benefit Option Claim Form
PDF template
A form for employees or members to claim an accelerated benefit option for terminal illness life insurance claims.
See template
See template
Key Electronic Access Request Form
PDF template
A form for requesting building and room access, keys, and electronic entry devices for employees and workers at an organization.
See template
See template
ERAIDER REQUEST FORM
PDF template
Form for non-TTUHSC employees to request an eRaider account, specifying access requirements and responsibilities.
See template
See template
Report Of Accident Incident
PDF template
A form for documenting workplace accidents or incidents involving university personnel, students, or workers.
See template
See template
Accident Injury Report
PDF template
Comprehensive document for reporting and documenting workplace accidents, injuries, and worker's compensation claims.
See template
See template
Accident Report Form
PDF template
Comprehensive form for documenting workplace accidents, injuries, and related incident details with personal and organizational information.
See template
See template
Waubun Ogema White Earth AccidentIncident Report Form
PDF template
A form used to document workplace accidents or incidents, capturing details about the event, potential prevention, and property damage.
See template
See template
AccidentIncident Report Form
PDF template
A comprehensive form for documenting workplace accidents or incidents at East Stroudsburg University by employees, students, and visitors.
See template
See template
City Of Kirkland Accident Report Form
PDF template
A comprehensive form for reporting workplace accidents, injuries, and potential liability claims for City of Kirkland employees.
See template
See template
Accident Wellness Benefit Claim Form
PDF template
Insurance claim form for submitting wellness screening benefits and personal health information to Guardian Life Insurance.
See template
See template
Payroll Cancellation Form ACC PYB001
PDF template
A government form for employees to cancel an existing payroll deduction for the Government of Guam.
See template
See template
Direct Deposit Form ACC PYD001
PDF template
Form for employees to set up, change, or cancel direct deposit for payroll with the Government of Guam.
See template
See template
Multi Location Travel Expense Reimbursement Request
PDF template
A comprehensive form for employees and students to request reimbursement for travel-related expenses at North Dakota State University.
See template
See template
Travel Expense Reimbursement Request
PDF template
A form for employees and students to request reimbursement for travel-related expenses at North Dakota State University.
See template
See template
Retirement Contribution Form
PDF template
A form for employers to set up electronic fund transfer (EFT) contributions to employee retirement accounts, specifically 403(b) and other retirement plans.
See template
See template
ACORD 126
PDF template
Insurance form for capturing details about employee benefits liability coverage and business insurance details.
See template
See template
Acquisition Matrix
PDF template
A matrix detailing procurement methods and approval requirements for various types of purchases at an educational institution.
See template
See template
Acquisition Matrix
PDF template
A detailed matrix outlining procurement guidelines and payment methods for various types of purchases at Cal Maritime.
See template
See template
ACSA Santa Clara County Region 8 Expense Voucher
PDF template
A reimbursement form for expense claims by members of the Association of California School Administrators in Santa Clara County Region 8.
See template
See template
Handbook For Travel Policy
PDF template
Comprehensive travel policy and procedure guide for U.S. Department of Education employees covering travel authorization, arrangements, per diem, and reimbursement.
See template
See template
Employee Application For Reimbursement Of Expenses Incurred Upon Sale Or Purchase (Or Both) Of Resid
PDF template
Government form for employees to claim reimbursement for relocation-related real estate expenses when changing official work station.
See template
See template
Reimbursement Or Advance Of Funds Agreement
PDF template
A government form for documenting financial agreements between agencies for service reimbursement or funds advancement.
See template
See template
Flexible Spending Account Direct Deposit Authorization Form
PDF template
Form for employees to authorize direct deposit of flexible spending account reimbursements with banking details.
See template
See template
Documentary Materials RemovalNon Removal Certification And Non Disclosure Agreement
PDF template
A certification document outlining rules for removing or retaining documentary materials when leaving USDA employment.
See template
See template
AD 3121 Employee Citizenship Form
PDF template
A form used by the U.S. Department of Agriculture to collect employee citizenship and birth information.
See template
See template
Sick Leave And Short Term Disability Policy
PDF template
Policy outlining sick leave provisions and short-term disability benefits for Champlain College employees, defining eligibility and guidelines for income replacement.
See template
See template
Reimbursement Of Travel Expenses For AdCom Members
PDF template
Policy detailing travel expense reimbursement guidelines for AdCom members, including maximum allowable amounts and submission requirements.
See template
See template
LOCAL 22 HEALTH PLAN DEPENDENT FORM
PDF template
Form for adding a spouse or dependent to the Local 22 Health Plan, requiring personal information and supporting documentation.
See template
See template
UWS B1242 Accidental Death Dismemberment Insurance
PDF template
Comprehensive employer manual for Accidental Death and Dismemberment insurance policy for University of Wisconsin System employees.
See template
See template
Change Of Address Form
PDF template
Official form for changing address for New Jersey state pension system members and retirees
See template
See template
NAMEADDRESSEMERGENCY CONTACT FORM
PDF template
A form for new hires and existing employees to update personal contact and emergency information
See template
See template
Address Changes
PDF template
Guidelines for updating employee and student addresses in the University's Directory System for payroll, retirement, and insurance correspondence.
See template
See template
PSC CUNY Welfare Fund Adjunct Enrollment Form
PDF template
Health benefits enrollment form for adjunct faculty members at CUNY with dental and health plan options
See template
See template
AdjustmentVoid Request Form
PDF template
A form used by healthcare providers to request adjustments or void payments for medical services.
See template
See template
ADM.FRM.1.001, FACT Travel Expense Reimbursement Form
PDF template
A form for submitting and documenting travel-related expenses for reimbursement by FACT organization.
See template
See template
Daemen College Employee Evaluation Instruction
PDF template
A comprehensive performance evaluation form for administrative personnel at Daemen College, detailing assessment criteria and development goals.
See template
See template
Discrimination Or Harassment Incident Report
PDF template
A formal document for reporting discrimination or harassment incidents within Prince George's County Public Schools by employees or volunteers.
See template
See template
C911CD Time Off Request Form
PDF template
A standardized form for employees to request time off from work, specifying leave type and duration.
See template
See template
Administrative Tuition Reimbursement Form
PDF template
Form for David Douglas School District employees to request tuition reimbursement for job-related courses and professional development.
See template
See template
ACADEMIC AND CLASSIFIED ADMINISTRATORS VOLUNTARY SICK LEAVE BANK CONTRIBUTION FORM NEW EMPLOYEE
PDF template
A voluntary form for academic and classified administrators to contribute sick leave days to a shared sick leave bank for potential future use by administrators.
See template
See template
Administrative Waiver How To Request Waiver For An Overpayment Under 1000
PDF template
Instructions for requesting an administrative waiver for Social Security overpayments less than $1,000.
See template
See template
Adoption Expenses Reimbursement Form For Lifesong For Orphans
PDF template
A form for submitting and tracking adoption-related expenses for reimbursement by Lifesong for Orphans.
See template
See template
Adoption Assistance Reimbursement Form
PDF template
Form for employees to request reimbursement for qualified adoption expenses through the university's adoption assistance program.
See template
See template
Adoption Reimbursement Policy
PDF template
Policy detailing adoption expense reimbursement for active employees of the Texas Annual Conference of the United Methodist Church, offering up to $5,000 per adopted child.
See template
See template
Adoption Benefit Financial Reimbursement Form
PDF template
A form for employees to request financial reimbursement for eligible adoption-related expenses up to $5,000 per child.
See template
See template
ALINE Card Enrollment Form
PDF template
Enrollment form for employees to set up direct deposit of wages to an ALINE Card issued by ADP and MB Financial Bank
See template
See template
Advance Authorization For Directly Sponsored Event
PDF template
Internal form for requesting and documenting approval for business-related events and associated expenses
See template
See template
Advanced Illness Benefit Application Form
PDF template
Application form for palliative care through the Advanced Illness Benefit for advanced cancer/oncology care by BEMAS medical aid scheme.
See template
See template
Advanced Illness Benefit Application Form
PDF template
Application form for palliative care through the Advanced Illness Benefit for advanced cancer/oncology care by Anglovaal Group Medical Scheme.
See template
See template
APPLICATION FOR ADVANCED LEAVE
PDF template
A form for county employees to request advanced leave due to catastrophic illness or injury for themselves or immediate family members.
See template
See template
Advanced SickAnnual Leave Request Form
PDF template
A form allowing employees to request advanced sick or annual leave during a pandemic when their leave banks are exhausted, with specific repayment terms.
See template
See template
ADVANCE TRAVELREGISTRATION REQUEST FORM
PDF template
A form for employees to request and obtain approval for official state business travel and conference registration.
See template
See template
SunAdvantage RRSPTFSA Sponsor Administration Guide
PDF template
A comprehensive guide for small business owners to manage employee retirement and savings plans with minimal administrative burden.
See template
See template
Army Emergency Relief Application For Financial Assistance
PDF template
Comprehensive application form for military personnel seeking emergency financial support from Army Emergency Relief (AER)
See template
See template
Commercial Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims to Aetna Pharmacy Management for reimbursement or processing.
See template
See template
Prescription Drug Claim Form
PDF template
A comprehensive form for submitting prescription drug claims to Aetna Pharmacy Management for reimbursement or processing.
See template
See template
WIGI Bill Residency Affidavit For Children And Spouses Of Eligible 5 Year Veterans
PDF template
Residency verification form for children and spouses of veterans seeking Wisconsin GI Bill educational benefits based on veteran's 5-year state residency.
See template
See template
Affidavit For Wellness Leave
PDF template
A form for University of Houston-Victoria employees to document health survey completion and physical exam for wellness leave incentive.
See template
See template
Photo ID Application Form
PDF template
A form for obtaining a photo identification badge for employees and affiliates at UCLA Health System and associated schools
See template
See template
M0272B Flexible Spending Account Claim Form
PDF template
Form for requesting reimbursement from a Flexible Spending Account for medical and dependent care expenses.
See template
See template
Initial Disability Claim Form
PDF template
Comprehensive form for filing a disability insurance claim covering various types of disability including accidents, sickness, pregnancy, and cancer.
See template
See template
AFLAC Optional Insurance
PDF template
Document detailing optional insurance offerings from AFLAC for the Housing Authority of the City of Los Angeles (HACLA)
See template
See template
AFSCME Local 127 PPO Benefits Matrix
PDF template
Comprehensive dental insurance plan detailing coverage levels for various dental treatments and services.
See template
See template
Departmental Pre Travel Form
PDF template
Form for documenting and requesting reimbursement for university-related travel expenses, including domestic and international trips.
See template
See template
OCFS LDSS 0792 Day Care Enrollment
PDF template
New York State form for enrolling a child in day care, collecting child and emergency contact information, and health details.
See template
See template
Benefits Committee Meeting Agenda
PDF template
Agenda for a Benefits Committee meeting discussing various benefits-related topics and goals for 2018/2019.
See template
See template
Benefits Committee Meeting Agenda
PDF template
Agenda for Benefits Committee meeting detailing review of minutes, old and new business items related to employee benefits.
See template
See template
Request For Payment
PDF template
A form for requesting payment for business-related expenses and invoices at the School of Medicine.
See template
See template
AGS Incident Near Miss Hazard Report Form FRM067 010519
PDF template
A workplace safety form for reporting incidents, near misses, hazards, or potential safety concerns within an organization.
See template
See template
Medical Reimbursement Form
PDF template
Form for members to request reimbursement for medical services covered under their health plan
See template
See template
Provider Claim Inquiry Form
PDF template
A form for healthcare providers to submit multiple claim status inquiries for reimbursement or dispute resolution.
See template
See template
AID Form 481 2 Paid Parental Leave (PPL) Request Form
PDF template
A form for USAID employees to request paid parental leave for birth, adoption, or foster care placement of a child.
See template
See template
Individual Family Life Insurance Form (Policy 32871 G)
PDF template
A form allowing employees to enroll in or increase life insurance coverage for themselves, spouse/domestic partner, and children during an annual enrollment period.
See template
See template
New York State Nonpublic School Reimbursement Request Form For Academic Intervention Services (AIS)
PDF template
A form for nonpublic schools in New York State to request reimbursement for academic intervention services and professional development materials.
See template
See template
Resident Assessment
PDF template
Comprehensive intake form for documenting a resident's medical history, health status, functional capabilities, and personal information for care facilities.
See template
See template
Alabama EWIC Vendor Kickoff Meeting
PDF template
Presentation explaining the electronic WIC benefits system for vendors in Alabama, detailing transaction processing and program benefits.
See template
See template
LEAVE REQUEST FORM COVID Related
PDF template
A comprehensive form for employees to request leave related to COVID-19 circumstances, covering various scenarios of quarantine, vaccination, and childcare needs.
See template
See template
Affidavit For Spousal Coverage
PDF template
Form for employees to certify spouse's eligibility for medical plan enrollment at Allegheny College by verifying no alternative employer health coverage.
See template
See template
Allied, Therapeutic And Psychology Extender Benefit Application Form For 2024
PDF template
Application form for healthcare benefit coverage under the Retail Medical Scheme's Essential Plus Option for allied, therapeutic, and psychology services.
See template
See template
Accident Coverage Claim Form
PDF template
Insurance claim form for reporting accidental injuries and seeking coverage benefits from American Heritage Life Insurance Company.
See template
See template
Blue Cross Medical Travel Benefit Claim
PDF template
A claim form for medical travel expenses for members of the Arrow Lakes Teachers' Association submitted to Pacific Blue Cross.
See template
See template
Alternate Work Arrangement Agreement Form
PDF template
A document for employees to request and document flexible work arrangements at Middle Tennessee State University.
See template
See template
AWL Equipment Inventory
PDF template
A form for documenting university-owned equipment issued to an employee for use at an alternate work location, including equipment tracking and usage agreement.
See template
See template
AWL Safety Checklist
PDF template
A comprehensive safety checklist for employees working in alternate work locations to ensure workspace safety and security.
See template
See template
Alternative Work Agreement Program
PDF template
Policy outlining flexible work arrangements including telecommuting, flex time, and compressed work weeks for Metro Parks Tacoma employees.
See template
See template
Enrollment Form
PDF template
A comprehensive enrollment form for dental and vision insurance coverage through an employer's benefit plan.
See template
See template
Enrollment Form
PDF template
A comprehensive form for enrolling in dental insurance coverage, including subscriber and dependent information, coverage options, and coordination of benefits.
See template
See template
ENROLLMENT FORM VISION ONLY
PDF template
A comprehensive enrollment form for vision insurance coverage, allowing employees to add or modify vision insurance benefits.
See template
See template
Alumni Dependent Scholarship Form
PDF template
Scholarship form for dependents of Oklahoma Wesleyan University alumni seeking financial aid for undergraduate studies.
See template
See template
University Of Iowa Amazon Order Form
PDF template
A form for University of Iowa student organizations to place Amazon orders using the university's purchase order system with specific accounting and approval requirements.
See template
See template
AME Reimbursement Request Form
PDF template
A form for University of Arizona employees and students to request reimbursement for expenses with detailed payee and receipt information.
See template
See template
Direct Deposit Authorization
PDF template
Authorization form for Otoe-Missouria Tribe members to receive per capita and TAP reimbursement deposits directly into their bank account.
See template
See template
PCARD PURCHASE FORM
PDF template
A form for documenting and authorizing purchases made using a university procurement card with tax exemption and expense tracking details.
See template
See template
Direct Deposit Form
PDF template
Form for authorizing direct deposit of flexible spending account reimbursements into an employee's checking account.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for submitting dental insurance claims, requiring patient and employee information, treatment details, and authorization signatures.
See template
See template
Enrollment Change Waiver Group Insurance Form
PDF template
Insurance form for enrolling, changing, or waiving group dental insurance coverage for employees and their dependents.
See template
See template
Hearing Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in or modify hearing insurance coverage for themselves and dependents.
See template
See template
Multiple Jurisdiction Tax Exemption Form
PDF template
Form for rail carrier employees to claim tax exemptions for work performed in multiple jurisdictions under federal law.
See template
See template
Annex B Fort Bend County Travel Policy
PDF template
Policy governing travel expenditures for county employees and officials, detailing eligible expenses, contract rates, and reimbursement procedures.
See template
See template
UA Performance Evaluation Comprehensive Form
PDF template
A comprehensive performance evaluation form for employees at the University of Alabama, detailing performance ratings and assessment criteria.
See template
See template
I.B.E.W. LOCAL UNION 363 MONEY PURCHASE PENSION PLAN Annuity Benefit Application Form
PDF template
A comprehensive form for members of I.B.E.W. Local Union #363 to apply for pension or annuity benefits, collecting personal, marital, and employment information.
See template
See template
Question Set G
PDF template
Survey for current and former Financial Conduct Authority employees seeking input and evidence on organizational matters.
See template
See template
Member Claim Form
PDF template
Insurance claim form for submitting medical expenses and service details to Anthem Blue Cross health insurance.
See template
See template
Anthem Blue Cross Enrollment Form
PDF template
Comprehensive enrollment form for selecting medical and dental insurance coverage through Anthem Blue Cross for employers and employees.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for patients to submit claims for prescription medication reimbursement from their insurance provider.
See template
See template
Medical Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service reimbursement claims to Anthem Blue Cross and Blue Shield insurance.
See template
See template
PPO Dental Blue Complete
PDF template
Comprehensive dental insurance plan offering flexible network options and preventive care coverage for active and retired police association members.
See template
See template
Short Term Disability Claim Form
PDF template
A form for employees to file a claim for short-term disability benefits with insurance details and authorization.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A claim form for submitting vision care expenses to Blue View Vision when receiving services from out-of-network providers.
See template
See template
Administrative Order No. 6 1 Travel On County Business
PDF template
Guidelines for travel authorization and reimbursement for Miami-Dade County officials and employees while conducting official business.
See template
See template
Administrative Order No. 3
PDF template
Administrative order revising procedures for employee discipline processing in the police department, focusing on telecommunications advances.
See template
See template
Reimbursement Of Expenses Procedure
PDF template
Procedure establishing the process for reimbursing business-related expenses for board members, employees, students, and volunteers at Western Nebraska Community College.
See template
See template
AP 3C3A(B) Claim For AbsenceTravel Reimbursement
PDF template
Procedures and guidelines for submitting travel expense claims and reimbursement for Kern Community College District employees.
See template
See template
Travel Procedure
PDF template
Procedure for regulating and reimbursing business travel expenses for staff members, outlining guidelines and responsibilities.
See template
See template
Administrative Procedure AP 7400 Travel
PDF template
A comprehensive administrative procedure outlining travel policies, expenses, and guidelines for district faculty, staff, board members, and other affiliated persons.
See template
See template
AP 9 Student Organization Account Payment Request
PDF template
A form for requesting direct payments to vendors or reimbursements for student organization expenses and purchases.
See template
See template
Employee Expense Direct Deposit Form
PDF template
Form for employees to set up or modify bank account information for expense reimbursement direct deposits at Carnegie Mellon University.
See template
See template
Expense Report Procedures
PDF template
Comprehensive procedures for completing and submitting corporate expense reports for Royal American Management, Inc. and affiliated companies.
See template
See template
Administrative Form AP F002 STAFF TRAVEL EXPENSE CLAIM FORM
PDF template
A form for employees to document and request reimbursement for travel-related expenses including meals, transportation, and other costs.
See template
See template
SF 270 Request For Advance Or Reimbursement
PDF template
Instructions for completing the Standard Form 270 to request grant funds through advance or reimbursement.
See template
See template
MPERS Expense Report
PDF template
A detailed form for tracking and reporting travel-related expenses including mileage, transportation, meals, and other incidental costs.
See template
See template
Instructions For Cost Reimbursement Budget Form And Budget Narrative
PDF template
Detailed guidelines for First 5 LA grantees on completing budget forms and budget narrative documentation for cost reimbursement agreements.
See template
See template
VOLUNTARY TIME OFF REQUEST FORM
PDF template
A form allowing employees to voluntarily reduce work hours and receive proportional salary reduction during the 2010-2011 fiscal year.
See template
See template
Applicant Interview Expense Report
PDF template
A form for job applicants to report and request reimbursement for interview-related expenses at Micron Technology.
See template
See template
Phased Retirement Application And Reemployment Agreement
PDF template
A voluntary program allowing faculty to transition to half-time employment while beginning retirement benefits and maintaining institutional connection.
See template
See template
Application For Member Survivor Allowance
PDF template
Form for survivors to apply for allowance benefits under Massachusetts General Laws, Chapter 32, Section 12A, pending approval of accidental death benefits.
See template
See template
Application Form For Extra Increase Single Pensioners
PDF template
A form for single pensioners in the Caribbean Netherlands to apply for an additional pension increase based on specific eligibility criteria.
See template
See template
Pension Application Form
PDF template
Comprehensive form for individuals applying for pension benefits, collecting personal, marital, and employment information.
See template
See template
COVID 19 Related Paid Sick Leave Request Form
PDF template
Form for employees to request paid sick leave related to COVID-19 under federal and New York state regulations.
See template
See template
Service Request Form
PDF template
A form for submitting and tracking information technology service requests within an organization.
See template
See template
How To Apply For An SVF Plan Retirement Benefit Or Survivor Benefit
PDF template
Detailed instructions for volunteer firefighters applying for retirement or survivor benefits through the PERA Statewide Volunteer Firefighter Plan.
See template
See template
APPROVAL FORM FOR EMPLOYEE REIMBURSEMENT
PDF template
A form used by supervisors to approve and document employee expense reimbursements.
See template
See template
APPLICATIONS Service Request Form
PDF template
Internal form for requesting IT service and system modifications within an organization's technology infrastructure.
See template
See template
Albuquerque Public Schools Domestic Partners Policy
PDF template
Policy outlining benefits eligibility for employees with domestic partners, including medical, dental, and insurance coverage.
See template
See template
Documentation And Approval Of Spousal And Family Travel Form
PDF template
A form for documenting and obtaining approval for travel expenses for spouses and family members accompanying an employee on a business trip.
See template
See template
APTA Technology Terms And Conditions White Paper
PDF template
A white paper discussing technology-related terms and conditions for IT procurement contracts in public transit agencies.
See template
See template
Travel Expense Statement
PDF template
A form for documenting and requesting reimbursement for travel-related expenses for Centenary College employees.
See template
See template
Payroll Donation Form
PDF template
A form allowing Ardent employees to donate to the Ardent Cares Foundation through payroll deductions to support team members in need.
See template
See template
Area Committee Expense Report Form
PDF template
A detailed form for tracking and reporting travel, organizational, and miscellaneous expenses for reimbursement.
See template
See template
Arizona State Carpenters Annuity Plan
PDF template
A defined contribution retirement plan for covered employees of the Arizona State Carpenters Retirement Fund, providing financial security and tax-deferred benefits.
See template
See template
Airport Rescue Grant Request For Reimbursement Form (ARPA)
PDF template
A form for Texas airports to request reimbursement for operational, maintenance, and debt service expenses under ARPA funding.
See template
See template
Pennsylvania State System Of Higher Education Alternative Retirement Plan Summary Plan Description
PDF template
Comprehensive summary of retirement plan details for Pennsylvania State System of Higher Education employees, covering participation, contributions, investments, and benefits.
See template
See template
How To Arrange And Pay For Interview Candidate Travel
PDF template
Guidelines for arranging and paying travel expenses for job interview candidates at the University of Wisconsin system
See template
See template
ASB REIMBURSEMENT REQUEST FORM
PDF template
A form for students to request reimbursement for school-related expenses with itemized receipts and signatures.
See template
See template
Employee Handbook
PDF template
Comprehensive guide outlining employment policies, employee conduct, compensation, and workplace guidelines for ASF employees.
See template
See template
Direct Deposit And Notification Enrollment Form
PDF template
Form for signing up for electronic account notifications and direct deposit reimbursements through ASIFlex.
See template
See template
ASMS Parent Club Reimbursement Request Form
PDF template
A form for requesting financial reimbursement from the ASMS Parent Club for approved expenses.
See template
See template
MEDICALVISION CLAIM FORM
PDF template
A comprehensive claim form for submitting medical and vision insurance claims, requiring detailed employee and patient information.
See template
See template
Campus Assemblies Reimbursement Request
PDF template
A form for submitting reimbursement requests for campus assembly expenses with detailed financial tracking.
See template
See template
Reimbursement Guidelines For Funded Attendees
PDF template
Guidelines for travel expense reimbursement for funded attendees, including transportation, meals, and lodging expenses.
See template
See template
CHECK LIST FOR FILLING OUT ATHLETIC TRAVEL REIMBURSEMENT FORM
PDF template
A comprehensive checklist for completing and submitting an athletic travel reimbursement form with detailed instructions for expense documentation.
See template
See template
ATHLETICS TRAVEL REIMBURSEMENT FORM
PDF template
A form for documenting and seeking reimbursement for travel expenses related to athletic team or recruiting activities.
See template
See template
Accessible Technology Purchase Form
PDF template
Form for requesting electronic and information technology purchases to ensure accessibility for students and users in academic settings.
See template
See template
Spending Plan
PDF template
A comprehensive financial worksheet for tracking monthly income, expenses, and financial obligations.
See template
See template
Administrative Regulation 95.91 Employee Rewards And Recognition Program ATTACHMENT 2 Employee Of T
PDF template
A form for nominating employees for quarterly or yearly recognition based on exceptional work performance and service.
See template
See template
School Training Attendance Record
PDF template
Document for tracking school attendance, childcare, housing, and transportation expenses for workforce training participants.
See template
See template
Form FMS PY1 Direct PaymentInvoice Form
PDF template
A form for teachers to request reimbursement for PRAXIS exam costs through their school or district office.
See template
See template
Fund Eligibility And Membership
PDF template
Document detailing eligibility requirements, enrollment procedures, and membership conditions for a health benefits fund.
See template
See template
Transportation Billing Routing Sheet
PDF template
A billing form for transportation expenses related to WIOA Title-IB activities, used by West Central Arkansas Planning and Development District.
See template
See template
ITEMIZED SCHEDULE OF TRAVEL EXPENSES
PDF template
Official state form for documenting and requesting reimbursement for travel expenses by government employees or board/commission members.
See template
See template
MILES COLLEGE ATTENDANCE FORM
PDF template
A monthly form for tracking employee work hours and attendance at Miles College, to be submitted to Human Resources by the 25th of each month.
See template
See template
Miles College Attendance Form
PDF template
A monthly form for tracking employee work hours and attendance at Miles College with spaces for detailed time tracking and signatures.
See template
See template
AUGUSTA UNIVERSITY FFCRA LEAVE REQUEST FORM
PDF template
Form for employees to request leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
See template
See template
Authorization And Driving History Form
PDF template
A form documenting employee driving authorization, vehicle operation details, and liability requirements for state vehicle use.
See template
See template
Authorization For Direct Deposit Via ACH
PDF template
A form authorizing the Queen Anne's County Board of Education to electronically deposit wages into one or two bank accounts.
See template
See template
Authorization Form For Payroll Check(S) To Be Mailed
PDF template
A form allowing employees of Bronx Community College to authorize mailing of their payroll checks to a specified address.
See template
See template
Authorization For The Administration Of Medication By Child Day Care Personnel
PDF template
A form for parents/guardians to authorize child day care personnel to administer medication to children, with prescriber and medication details.
See template
See template
Authorization To Receive Compensatory TimeOvertime
PDF template
A university form for employees to request and obtain approval for overtime work or compensatory time
See template
See template
Nomination Form
PDF template
A form for nominating an individual for recognition within an organization, capturing details about the nominee and nominator.
See template
See template
Directors Compensation And Expense Reimbursement Policy
PDF template
Policy detailing compensation and expense reimbursement for Amador Water Agency Board of Directors, including daily meeting rates and monthly compensation limits.
See template
See template
Award Agreement (Agreement To Pay Benefits)
PDF template
Official form documenting workers' compensation benefits agreement between an injured worker and employer/insurance carrier.
See template
See template
Dependent Care Claim Form
PDF template
A form for employees to claim reimbursement for dependent care expenses through a flexible spending account.
See template
See template
Medical Expense Claim Form
PDF template
A form for employees to claim medical expenses through a Flexible Spending Account with detailed submission instructions.
See template
See template
Member Request For Medical Reimbursement Form
PDF template
A form used by UnitedHealthcare Community Plan members to request reimbursement for medical services, co-payments, coinsurance, and deductibles.
See template
See template
Request For Leave
PDF template
A comprehensive form for school employees to request various types of leave, including sick, vacation, personal, and special leaves.
See template
See template
Benefit Application Form (BA1)
PDF template
Application form for members of the New Zealand Firefighters Welfare Society to claim benefits and reimbursements.
See template
See template
OP 95 5 02 Backward Deferred Retirement Option Plan (Back DROP)
PDF template
Operational policy detailing the process for Fire and Police Pension Plan members to apply for retirement using the Backward Deferred Retirement Option Plan.
See template
See template
Chronic Appliance Benefit Application Form
PDF template
Medical application form for patients seeking insurance coverage for chronic medical appliances and equipment through Bankmed.
See template
See template
Banner System Access Request Form
PDF template
A form for employees or individuals requesting new or modified access to the Banner system with specific access level details.
See template
See template
BANNER UNIX ACCOUNT APPLICATION FOR EMPLOYEES
PDF template
Form for employees to request access to various Banner modules and Unix accounts at Texas Southern University
See template
See template
BANNER UNIX ACCOUNT APPLICATION FOR EMPLOYEES
PDF template
Form for requesting access to Banner and Unix system modules for Texas Southern University employees
See template
See template
BASIC PENSION APPLICATION
PDF template
A comprehensive pension application form for members of the Southern California Pipe Trades Retirement Fund seeking to apply for retirement benefits.
See template
See template
Form B.1 IL 569 00002
PDF template
Form for law enforcement agencies to claim reimbursement for basic training of law enforcement, corrections, and court security personnel.
See template
See template
Entering Time For Astrix Benefit Hours An EmployeeS Quick Reference Guide
PDF template
A guide for employees on how to enter benefit hours including PTO, holiday, and sick leave using the online timesheet application.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for documenting medical treatment, injury, or preventive care for reimbursement purposes.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient details, treatment information, and other coverage details.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for submitting medical treatment claims with detailed patient and treatment information.
See template
See template
Member Reimbursement
PDF template
A form for members to request reimbursement for healthcare expenses paid out-of-pocket directly to providers.
See template
See template
Member Reimbursement
PDF template
A form for Blue Cross Blue Shield members to request reimbursement for healthcare expenses paid out of pocket.
See template
See template
Medical Expense Claim
PDF template
A claim form for submitting medical expenses to Blue Cross and Blue Shield of Alabama for reimbursement.
See template
See template
Member Reimbursement
PDF template
Form for members to request reimbursement for healthcare expenses paid out-of-pocket.
See template
See template
Member Claim Form
PDF template
A form for filing healthcare claims with Blue Cross Blue Shield of North Carolina, detailing patient and insurance information for reimbursement of medical services.
See template
See template
Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims, allowing members to request reimbursement for pharmacy expenses.
See template
See template
REIMBURSEMENT FORM FOR MEMBERS OF BOARDS, COMMITTEES, AND COMMISSIONS
PDF template
A form for county board, committee, and commission members to request reimbursement for transportation and dependent care expenses related to meetings.
See template
See template
My Benefit Plan Summary
PDF template
Comprehensive healthcare benefit plan summary for SEIU Clerical Employees detailing coverage limits and medical benefits.
See template
See template
My Benefit Plan Summary
PDF template
Comprehensive health benefits summary for full-time employees of Brant Community Healthcare System through Green Shield Canada.
See template
See template
Group Administration Manual
PDF template
A comprehensive guide for group administrators on managing health coverage and enrollment for employees through Anthem Blue Cross.
See template
See template
Member Billing Form
PDF template
A form for submitting medical bills from non-participating healthcare providers for reimbursement or claim processing.
See template
See template
Member Reimbursement Form
PDF template
A form for healthcare members to request reimbursement for out-of-pocket medical expenses they have paid directly.
See template
See template
BCS Fellow (FBCS) Application Guidance For OMs
PDF template
Comprehensive guidance for professionals applying to become a BCS Fellow, detailing application requirements and criteria.
See template
See template
Mental HealthSubstance Use Treatment Claim Form
PDF template
A claim form for submitting mental health and substance use treatment services to Beacon Health Options for reimbursement.
See template
See template
Self Service Employee Business Expenses
PDF template
A comprehensive guide for employees to submit and track business expense reimbursements through a self-service system, including instructions and IRS compliance details.
See template
See template
BENEFIT APPLICATION FORM
PDF template
Application form for pension fund withdrawal with personal and employment details
See template
See template
Benefit Application Form
PDF template
A form for youth members of the Sipekne'katik First Nation to apply for benefits from their trust.
See template
See template
Direct Deposit Form
PDF template
Form for employees to set up direct deposit for benefits reimbursements with bank account details and authorization.
See template
See template
M NCPPC BENEFITS ENROLLMENTCHANGE FORM
PDF template
Form for employees to enroll or change benefits, covering medical, dental, and prescription plans for new hires or those experiencing qualifying life events.
See template
See template
Benefits Billing Form
PDF template
A form for employees to elect benefits continuation options during FMLA or general leave of absence
See template
See template
Benefits Cancellation Form
PDF template
Form used to remove dependents from an employee's benefits plan and modify coverage options.
See template
See template
Benefits Cancellation Form
PDF template
Form for employees to cancel or modify health, dental, and life insurance benefits with Haverhill Public Schools.
See template
See template
Summary Of Employee Benefits
PDF template
Comprehensive guide detailing health insurance and benefit options for employees of the Research Foundation for Mental Hygiene, Inc.
See template
See template
Dental Insurance Plan
PDF template
Insurance plan detailing dental coverage eligibility for employees and their dependents at the University of Nebraska.
See template
See template
Benefits Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and optional insurance benefits
See template
See template
Benefits Summary
PDF template
Comprehensive document detailing paid time off (PTO), holiday, and sick time policies for full-time and part-time employees.
See template
See template
ENERGY BENEFIT TRANSFER REQUEST FORM
PDF template
A form for transferring energy benefits between utility vendors and documenting account changes.
See template
See template
Blind Vendor Health Insurance Reimbursement Form
PDF template
A form for blind vendors to request reimbursement for medical services and expenses.
See template
See template
BEREAVEMENT LEAVE APPROVAL REQUEST
PDF template
A form for employees to request bereavement leave following the death of an immediate family member with specific guidelines on leave duration and eligibility.
See template
See template
Bereavement Leave Request Form
PDF template
A form for employees to request paid leave following the death of an immediate family member, with specific provisions for leave duration based on funeral location.
See template
See template
Bereavement Leave Request Form
PDF template
A form for employees to request paid leave following the death of an immediate family member at Northwest University.
See template
See template
Bereavement Leave Request Form
PDF template
A form for employees to request time off following the death of a family member or household member, with provisions for up to ten working days of leave.
See template
See template
Butterfly Club Opportunity Drawing Ticket Deduction Form
PDF template
Employee authorization form for purchasing Butterfly Club event tickets via payroll deduction
See template
See template
Benefits 2 Work Enrollment Form
PDF template
A comprehensive form for San Francisco residents seeking employment benefits and counseling, particularly targeting seniors, disabled individuals, and those with limited employment prospects.
See template
See template
Direct Deposit Enrollment For Stipends From The Ben Hudnall Memorial Trust (BHMT) Education Program
PDF template
A form for Kaiser Permanente employees to enroll, change, or terminate direct deposit of stipend payments through the Ben Hudnall Memorial Trust education program.
See template
See template
Billing 101 What You Need To Know
PDF template
A comprehensive guide addressing billing, reimbursement, and professional practice considerations for athletic trainers seeking third-party payor reimbursement.
See template
See template
Billing Form For In Home Supportive Services
PDF template
A form for victims to request reimbursement for in-home supportive services related to a crime-related injury.
See template
See template
Grant In Aid Billing Form
PDF template
Form for trail clubs to request reimbursement for trail maintenance and equipment expenses from state grant funds.
See template
See template
Billing FormResearch
PDF template
Form for requesting payment and invoicing for research-related expenses from a funding organization.
See template
See template
Update Personal Information
PDF template
A form for employees to update their personal contact details and emergency contact information.
See template
See template
Post DocTrainee Billing Form
PDF template
A form for managing billing and payment details for post-doctoral trainees and their associated departments at the University of Utah.
See template
See template
We CanT Wait Act Of 2023
PDF template
A bill to allow disabled individuals to elect to receive disability insurance benefits during the mandatory waiting period.
See template
See template
We CanT Wait Act Of 2024
PDF template
A bill to permit disabled individuals to elect to receive disability insurance benefits during the waiting period.
See template
See template
Reimbursement Form
PDF template
Comprehensive instructions for submitting travel and expense reimbursement requests for the Fischell Department of Bioengineering.
See template
See template
Reimbursement Form
PDF template
Comprehensive instructions for submitting travel and expense reimbursement requests for University of Maryland personnel and travelers.
See template
See template
Petty Cash Reimbursement Form
PDF template
A form for employees to request reimbursement for small business expenses not exceeding $50 per day.
See template
See template
Snow College Business Cards Order Form
PDF template
A form for Snow College employees to order personalized business cards with various printing options.
See template
See template
Employee Time Off Request Form
PDF template
A standardized form for employees to request various types of leave and obtain manager approval.
See template
See template
Health Savings Account (HSA) Payroll Deduction Form
PDF template
Form for employees to authorize automatic payroll deductions into their health savings account (HSA)
See template
See template
Performance Review Form
PDF template
A comprehensive document for assessing employee job performance, setting future goals, and providing overall performance ratings.
See template
See template
Member Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service expenses to Anthem Blue Cross insurance.
See template
See template
Blue View VisionSM Reimbursement Form
PDF template
A form for submitting out-of-network vision care service reimbursement claims to Blue View Vision insurance.
See template
See template
BOARD OF DIRECTORS TRAVEL FORM Board Meetings Authorization And Advance Request
PDF template
A form for NAESP board members to request travel authorization, advance funds, and provide trip details for board meetings.
See template
See template
Board Of Directors Shareholders EXPENSE REPORT FORM
PDF template
A form for board members and shareholders to submit expenses for reimbursement, detailing travel and per diem costs.
See template
See template
Bond Agreement Between Employee And Employer
PDF template
A legal document outlining the terms of employment, including potential financial obligations and restrictions for employees.
See template
See template
Unemployment Insurance Benefit Payment Guidance
PDF template
Instructions for employers on preventing improper unemployment insurance benefit payments and reducing potential tax impacts.
See template
See template
Pension Plan Benefit Application Form
PDF template
A comprehensive form for union members to apply for pension benefits, covering member information, reason for benefit request, and required certifications.
See template
See template
Bravo Award Nomination Form
PDF template
A multi-section form for nominating employees for performance awards with various approval levels and award amounts.
See template
See template
Bright Directions Payroll Deduction Form
PDF template
Form for initiating, changing, or stopping payroll deductions for Bright Directions College Savings Program accounts.
See template
See template
Brightline Employee Special Offers
PDF template
Transportation pass details for employees with special pricing between Miami, Fort Lauderdale, and West Palm Beach stations.
See template
See template
Bucknell Travel Policy
PDF template
Comprehensive policy guide for travel expenses, reimbursement, and special travel situations for university employees and affiliates.
See template
See template
BursarS Office Form 15A Application For Staff Fee Remission When Auditing A Course
PDF template
A form for qualified university staff to apply for fee-free course auditing without receiving academic credit.
See template
See template
Bursar Payroll Deduction Authorization
PDF template
A form allowing employees to authorize or cancel payroll deductions for their bursar account at Xavier University.
See template
See template
Burton Elementary School PTA Check Requisition Form
PDF template
A form used by the Burton Elementary School PTA to request and document check payments for school events and expenses.
See template
See template
Business Card Order Form
PDF template
A form for employees to request and order personalized business cards through an online ordering system.
See template
See template
Business Expense Policy
PDF template
A comprehensive policy detailing expense guidelines for Worcester Polytechnic Institute faculty, staff, and students when conducting university business.
See template
See template
HSS Business Expense Reimbursement Request
PDF template
Form for requesting reimbursement of business-related expenses including meals and general costs for university personnel.
See template
See template
EXPENSE REIMBURSEMENT FORM
PDF template
Procedure for submitting and processing expense reimbursement requests for employees and trustees of County College of Morris.
See template
See template
Payroll Time And Attendance Form Preparation
PDF template
Procedure manual detailing the process for completing payroll time and attendance forms at County College of Morris.
See template
See template
Business Meal Reimbursement Form
PDF template
Form for requesting reimbursement for business meals at the University of Houston, with specific documentation requirements.
See template
See template
Employee Requisition Form
PDF template
Formal document for requesting and approving new or replacement employee positions within the university's organizational structure.
See template
See template
Reimbursement Certification And Approval Form
PDF template
A document for certifying and approving expense reimbursements at Miami University.
See template
See template
Form SSA 634 Request For Change In Overpayment Recovery Rate
PDF template
A form for individuals to request adjustment of Social Security overpayment recovery based on financial hardship and inability to meet necessary living expenses.
See template
See template
MATERIALS ANDOR SUPPLIES REIMBURSEMENT FORM
PDF template
A form for employees to request reimbursement for materials and supplies purchased for school or departmental use.
See template
See template
Opinion Of Trustees ROD Case No. CA 0097
PDF template
A legal opinion addressing a dispute over prescription pre-authorization requirements for Viagra benefits under the Coal Industry Retiree Benefit Act.
See template
See template
Domestic Travel Request Form
PDF template
A form for requesting and documenting domestic travel arrangements, expenses, and approvals for institutional travel.
See template
See template
Payroll Check Direct Deposit Authorization
PDF template
A form for employees to authorize electronic transfer of payroll funds to one or multiple bank accounts.
See template
See template
WEST VIRGINIA WESLEYAN COLLEGE CAFETERIA PLAN MEDICAL CARE EXPENSE CLAIM FORM
PDF template
A form for submitting medical expense reimbursement claims under a cafeteria plan with detailed certification and documentation requirements.
See template
See template
Compeer Activity Reimbursement Form
PDF template
A form for mental health consumers to request reimbursement for expenses during outings with volunteer companions, up to $8.00 per week.
See template
See template
CAGONT Student Travel Form
PDF template
A form for students to document and request reimbursement for travel expenses related to academic activities.
See template
See template
Student Travel Form
PDF template
A form for students to request travel expense reimbursement with details about travel mode, costs, and passenger information.
See template
See template
CAH Termination Policy
PDF template
Comprehensive policy detailing exit procedures for employees leaving the University of Central Florida's College of Arts and Humanities.
See template
See template
Member Reimbursement Claim Form
PDF template
Detailed instructions for submitting a medical reimbursement claim to an insurance provider with guidelines for documentation and submission process.
See template
See template
Special Power Of Attorney
PDF template
A legal document allowing individuals to designate representatives for retirement-related decisions within CalPERS, LRS, and JRS systems.
See template
See template
Payroll Deduction Authorization
PDF template
Authorization form for North Carolina A&T State University employees to deduct recreation center fees from payroll
See template
See template
EXHIBIT A FOOD EXPENSE APPROVAL FORM
PDF template
A form for documenting and obtaining approvals for food-related expenses in an organizational setting.
See template
See template
Canada Manitoba Housing Benefit Homelessness Stream Application
PDF template
Application for financial housing support for individuals at risk of or experiencing homelessness in Manitoba.
See template
See template
Request To Cancel Coverage Form
PDF template
A form detailing reasons and documentation required for canceling health insurance coverage with specific qualifying events.
See template
See template
Miscellaneous Deductions And Insurances Cancellation Form
PDF template
Form for cancelling optional insurance plans and miscellaneous deductions not subject to pre-tax restrictions.
See template
See template
CLAIM FORM AND INSTRUCTIONS
PDF template
A comprehensive insurance claim form for filing wellness exam benefits with instructions for submission and processing.
See template
See template
Candidate Reimbursement Form
PDF template
A form for candidates to submit travel and expense reimbursement details for job search-related activities.
See template
See template
CAP Radio Travel Request
PDF template
A form for submitting and obtaining approval for business travel expenses and trip details.
See template
See template
Prescription Drug Claim Form
PDF template
A comprehensive form for submitting prescription drug claims, including standard, compound, and Medicare-related prescriptions and test kits.
See template
See template
Staff Council CARE Award Nomination Form
PDF template
A form to nominate University of Texas at Dallas staff members for recognition of outstanding performance and service.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims with detailed patient and insurance information requirements.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider or healthcare plan.
See template
See template
CAS Business Center Travel Reimbursement Form
PDF template
Document for submitting travel-related expenses and reimbursement details for University of North Carolina employees.
See template
See template
Direct Deposit Form
PDF template
A form for employees to provide bank account details for direct deposit of reimbursements from Consolidated Admin Services.
See template
See template
Cash Advance Request Form
PDF template
A form for employees to request and document cash advances for travel or business-related expenses with required approvals and signatures.
See template
See template
CASH REIMBURSEMENT FORM
PDF template
A form for submitting and documenting expenses for reimbursement within an organization or educational institution.
See template
See template
Check Cash Request Form
PDF template
A document for requesting cash or check payments, with options for mailing, direct deposit, and reimbursement details.
See template
See template
Leave Donation Request City Of Fond Du Lac
PDF template
A confidential form allowing employees to request donated sick, vacation, or floating holiday hours from colleagues during a medical hardship.
See template
See template
Catholic Charities Contribution Form
PDF template
A payroll form allowing University of Portland employees to initiate or terminate recurring charitable contributions to Catholic Charities.
See template
See template
SAP Payroll Time Management Time Entry
PDF template
Documentation for recording employee timesheet data in SAP time management system for University of Mississippi departments.
See template
See template
CBNA Travel Policies And CDB Travel Award
PDF template
Comprehensive travel expense and reimbursement policy for CBNA with details on submission process, funding sources, and travel awards.
See template
See template
CBNA Travel Policies
PDF template
Comprehensive guide for submitting travel expense forms, booking travel, and obtaining travel awards for graduate students.
See template
See template
Community Benefit Application Form
PDF template
An annual application process for community facilities and small businesses to receive support for community development projects from Sennit Construction.
See template
See template
CarerS Credit Application Form
PDF template
An application form for individuals providing care to claim Carer's Credit, a National Insurance credit for carers.
See template
See template
Reimbursement Form
PDF template
Official form for filing a reimbursement claim against the State of Illinois through the Court of Claims.
See template
See template
Child Care Attendance Forms And Reimbursement Guidelines
PDF template
Guidelines for processing child care attendance forms and reimbursement for Solano Family & Children's Services providers.
See template
See template
CCC Time Off Request Form
PDF template
A form for employees to request time off, including vacation, sick leave, or day-for-day leave for exempt employees.
See template
See template
CCOC Travel Policy And Procedures
PDF template
Policy establishing regulations and procedures for travel expenses and reimbursement for CCOC employees and authorized persons.
See template
See template
Cultural Competency Professional Development (CCPD) Credit By Attendance Form
PDF template
A form for employees to document and request credit for professional development activities related to cultural competency and equity training.
See template
See template
Campus Community Relations Expense Report
PDF template
A multi-request expense reporting form for capturing campus community relations expenditures at SDSU
See template
See template
CCSA Child Care Scholarship Monthly Attendance Worksheet
PDF template
Monthly tracking form for child care facilities to report attendance, fees, and compliance for scholarship program reimbursement.
See template
See template
LEAVE REQUEST CERTIFIED
PDF template
A comprehensive form for employees to request various types of leave, including sick leave, personal leave, and FMLA/OFLA.
See template
See template
CHECK REQUISITION FORM
PDF template
A financial document used to request and authorize the issuance of a check with mandatory supporting documentation requirements.
See template
See template
Safety Committee Policy
PDF template
Policy establishing the formation, membership, and purpose of a safety committee for the Deschutes County Adult Jail to promote workplace safety and health.
See template
See template
Safety Committee Policy
PDF template
Policy establishing a workplace safety committee for the Deschutes County Adult Jail to promote workplace safety and health through cooperative efforts.
See template
See template
REIMBURSEMENT FORM FOR MEMBERS OF BOARDS, COMMITTEES, AND COMMISSIONS
PDF template
Form for requesting reimbursement of travel and dependent care expenses for county board, committee, and commission members.
See template
See template
CDPHP Co Pay Reimbursement Form
PDF template
Form for employees to submit medical co-pay expenses for reimbursement through Hudson Valley Community College's healthcare program.
See template
See template
CEIAS Capstone Project Expenses Purchase Request Instructions
PDF template
Instructions for submitting purchase and reimbursement requests for capstone project expenses at NAU, including budget management and vendor communication guidelines.
See template
See template
Cell Phone Allowance Cancellation Form
PDF template
A form to cancel cell phone reimbursement for employees of the University of Utah's Payroll Department.
See template
See template
CEM Employee Travel Authorization Form
PDF template
A form for obtaining departmental approval and documenting travel expenses for employee business trips.
See template
See template
APPLICATION FOR DISABILITY BENEFIT
PDF template
Application form for disability benefits from the Central States, Southeast and Southwest Areas Pension Fund for eligible participants.
See template
See template
Central States Pension Fund Retirement Declaration
PDF template
A document for declaring retirement date, employment status, and receiving pension benefits from the Central States Pension Fund.
See template
See template
Classified Employee Of The Month Nomination Form
PDF template
A form for nominating exceptional classified employees at the College of Southern Nevada for monthly recognition and awards.
See template
See template
College Of Southern Nevada Classified Employee Of The Month Nomination Form
PDF template
A form to recognize and nominate exceptional classified employees at the College of Southern Nevada for monthly recognition.
See template
See template
California Employers Retiree Benefit Trust Sub Account Contribution Form
PDF template
A form for making contributions to multiple California Employers' Retiree Benefit Trust sub-accounts for different employee bargaining units.
See template
See template
Certificated Catastrophic Leave Application
PDF template
A form for employees to request catastrophic leave days through bank donation, direct donation, or additional sick leave for serious medical conditions or family care.
See template
See template
Certificated Employee Resignation Form
PDF template
A form for certificated employees of Vacaville Unified School District to resign from their position and document retirement benefits election.
See template
See template
CERTIFICATION AGREEMENT
PDF template
A certification form for veterans and dependents seeking educational benefits through VA programs at Santa Monica College.
See template
See template
Certification Reimbursement Form
PDF template
A form for Perry Tech students to request reimbursement for approved industry certification exams up to $500 upon successful test completion.
See template
See template
BDA Travel Form
PDF template
A travel request and expense tracking form for travelers within the Bureau of Disability Adjudication
See template
See template
EMPLOYEE PAID TIME OFF REQUEST FORM
PDF template
A form for CFS SDS employees to request and track paid time-off hours, requiring employee and HR signatures.
See template
See template
CGMA Client Information Form
PDF template
A form for Coast Guard personnel to request reimbursement for special needs dependent educational evaluations and support plans.
See template
See template
WV Income Maintenance Manual Chapter 2
PDF template
Guidelines for reporting changes and maintaining SNAP (Supplemental Nutrition Assistance Program) case eligibility in West Virginia.
See template
See template
Change Direct Deposit
PDF template
Instructions for changing direct deposit payment method by completing and uploading a form to the Benefits Portal.
See template
See template
STANDARD CHANGE FORM
PDF template
A form used for updating employee payroll information, deductions, and status for existing employees or new hires.
See template
See template
GROUP POLICY CHANGE FORM
PDF template
A form for employees to request changes to their group insurance policy details and dependent status.
See template
See template
Change Of Address Form
PDF template
Form for updating personal contact information for 1199SEIU Benefit Funds members.
See template
See template
NEW ADDRESS CHECKLIST (ACTIVE RETIRED)
PDF template
Guide for active and retired members of the Uniformed Firefighters Association to update their contact information and address.
See template
See template
Address Change Request
PDF template
Form for employees to update their contact information in the company's HR system (PeopleSoft)
See template
See template
Change Of Address Form
PDF template
Official form for employees to update personal contact information and address details with the City University of New York (CUNY) Office of Human Resources.
See template
See template
Employee Change Of Address Form
PDF template
A form for employees to update their personal contact and address information with their employer.
See template
See template
CHANGE OF ADDRESS FORM
PDF template
A form for employees to update their mailing address with the Office of Human Resources.
See template
See template
Employee Change Of Address Form
PDF template
A form for Puyallup Tribe of Indians employees to update their personal contact and address information with Human Resources.
See template
See template
Change Of Name And Address Policy
PDF template
Policy outlining the process for employees to update their personal information with the university's Human Resources department within 30 days of changes.
See template
See template
Tribal Travel Regulation
PDF template
Guidelines for travel expenses, reimbursement, and accommodation for tribal representatives and officials.
See template
See template
VA Form 22 1990 Application For VA Education Benefits
PDF template
Official application form for veterans seeking educational assistance benefits through VA programs like Montgomery GI Bill.
See template
See template
THE PRAIRIE ENTHUSIASTS CREDIT CARD PURCHASE FORM (CCPF)
PDF template
A form for documenting and tracking credit card purchases for The Prairie Enthusiasts organization
See template
See template
2024 FSA Enrollment Form
PDF template
Annual enrollment form for flexible spending accounts covering healthcare, limited healthcare, and dependent daycare expenses for the 2024 plan year.
See template
See template
Retirement Checklist
PDF template
Comprehensive checklist for teachers preparing to retire, detailing required documentation and steps to complete before retirement.
See template
See template
Texas Standard Incident Reimbursement Package
PDF template
Comprehensive guide for documenting and submitting reimbursement claims for personnel deployed in disaster response mutual aid efforts.
See template
See template
Checklist To Enroll In Retiree Health Insurance
PDF template
Step-by-step instructions for Dutchess County employees enrolling in retiree health insurance and Medicare
See template
See template
CHECK REQUEST REIMBURSEMENT FORM
PDF template
A form used to request a check payment or request reimbursement for expenses with supporting documentation.
See template
See template
Check Request Form
PDF template
A form used to request check payments with details about payee, amount, and delivery instructions.
See template
See template
Check Request Form
PDF template
A form for requesting financial checks within the Langford Area School District, requiring detailed payment information and approval signatures.
See template
See template
NACCS Check Requisition 2010
PDF template
A form for requesting and documenting check issuance within the NACCS organization, including details about the payee, amount, and funding source.
See template
See template
Check Request Reimbursement Form
PDF template
A form for requesting reimbursement checks, allowing individuals to submit details for financial compensation.
See template
See template
Check Requisition Form
PDF template
A form used to request and document the processing of a check payment with supporting information and approvals.
See template
See template
Travel Reimbursement Form
PDF template
A form for documenting and requesting travel expenses and reimbursements for university personnel.
See template
See template
Cheque Requisition Form
PDF template
A form used to request and process payment by cheque, detailing recipient and payment information.
See template
See template
COPERS Change Of Address Form
PDF template
A form for retired city employees to update their contact information with the City of Phoenix Employees' Retirement System.
See template
See template
Child Care Grant Application Form
PDF template
Application form for conference attendees to receive up to $500 in child care expense reimbursement during conference attendance.
See template
See template
Child Care Reimbursement Form
PDF template
Form for jurors to claim child care expenses incurred during jury service in Hennepin County, Minnesota.
See template
See template
Academic Student Employee (ASE) And Graduate Student Researcher (GSR) Childcare Reimbursement
PDF template
Form for UAW-represented student employees to request reimbursement of eligible childcare expenses at the University of California.
See template
See template
Child Pension Application
PDF template
Detailed document outlining application requirements for child's pension from the Government Employees Pension Fund (GEPF)
See template
See template
Choice PCA Paid Time Off Request Form
PDF template
A form for Choice PCA employees to request paid time-off from their client, requiring approval and submission to payroll.
See template
See template
COVID 19 FDA Authorized Over The Counter Test Member Reimbursement Form
PDF template
Form for members to request reimbursement for authorized FDA over-the-counter COVID-19 tests, with specific guidelines and limitations.
See template
See template
Chronic Illness Benefit Application Form
PDF template
An application form for patients seeking chronic illness benefits through the Glencore Medical Scheme, detailing submission requirements and contact information.
See template
See template
Student Loan Repayment Program
PDF template
Official instruction establishing Coast Guard policy for student loan repayment benefits for civilian employees.
See template
See template
Countermeasures Injury Compensation Program Request For Benefits Form
PDF template
Form for individuals seeking medical and employment benefits after experiencing a serious injury from a covered countermeasure such as vaccines or medical equipment.
See template
See template
Cigna Claim Form (Rev. 72015)
PDF template
A comprehensive form for submitting healthcare service reimbursement claims with patient, provider, and payment information.
See template
See template
Enrollment Change Form (Consolidated)
PDF template
A comprehensive form for employees to enroll or change health insurance and related benefits with multiple coverage options.
See template
See template
Medical Claim Form
PDF template
Form for submitting medical claims for fellows, trainees, and patients seeking international health insurance reimbursement.
See template
See template
CIMERLI Solutions Enrollment Form
PDF template
Comprehensive enrollment form for healthcare services, insurance verification, and patient assistance programs offered by CIMERLI Solutions
See template
See template
FAMILY FIRST CORONAVIRUS RESPONSE ACT (FFCRA) OREGON FAMILY LEAVE ACT (OFLA) LEAVE REQUEST FORM
PDF template
A form for employees to request leave under FFCRA and OFLA due to COVID-19 related reasons.
See template
See template
City Of Takoma Park MD Enrollment And Contribution Form
PDF template
Form for employees to enroll in and contribute to the City of Takoma Park's 457 Deferred Compensation Plan at MissionSquare Retirement.
See template
See template
Paid Parental Leave (PPL) Request Form
PDF template
A form for employees to request paid parental leave for birth, adoption, or foster care placement of a child.
See template
See template
Military Connected New Student Checklist
PDF template
A comprehensive guide for military-connected students transitioning to Northern Arizona University (NAU), covering benefit applications and campus resources.
See template
See template
Dynamic Invoice Form BLR 05620
PDF template
Circular letter introducing a revised dynamic invoice form for local public agencies requesting reimbursement of funds through specific programs.
See template
See template
MEDICAL EXPENSE CLAIM
PDF template
Form for filing medical expense claims with Blue Cross and Blue Shield of Alabama when a healthcare provider does not file a claim directly.
See template
See template
Claims Adjustments And Project Form
PDF template
A form for healthcare providers to request claims adjustments, retractions, or resolution of billing issues with WellSense Health Plan.
See template
See template
Virginia Workers Compensation Commission Claim Form
PDF template
Official form for filing a workers' compensation claim in Virginia, documenting workplace injury details and requesting benefits.
See template
See template
CIEE Claim Form
PDF template
A comprehensive medical claim form for student health insurance reimbursement and documentation of medical conditions or treatments.
See template
See template
Prescription Claim Form
PDF template
A form for submitting prescription reimbursement claims under a Medicare Part D manufacturer patient assistance program
See template
See template
Claim Form Finder And User Guide
PDF template
Comprehensive guide to help healthcare providers select the appropriate claim form for various submission scenarios and corrections.
See template
See template
Claim Form Finder
PDF template
Comprehensive guide for healthcare providers detailing claim modification forms and processes for Neighborhood Health Plan of Rhode Island.
See template
See template
Claim Form ICS Non Medical Expenses
PDF template
A comprehensive claim form for reporting non-medical insurance damages across multiple insurance types including household contents, travel/baggage, liability, and extra costs.
See template
See template
VSP Member Reimbursement Form
PDF template
A form for VSP vision care members to request reimbursement for vision-related services and expenses.
See template
See template
Claim Inquiry Form
PDF template
A form for healthcare providers to submit claim-related inquiries to Carelon Behavioral Health regarding claim status, denials, or clarifications.
See template
See template
Retiree Claim For Reimbursement
PDF template
A form for retirees to submit healthcare expense reimbursement claims through their health reimbursement arrangement (HRA)
See template
See template
Claim For Reimbursement
PDF template
Official form for claiming unclaimed funds from the Superior Court of Contra Costa County, California.
See template
See template
MVP Health Care Claim Reimbursement Form
PDF template
Detailed instructions for MVP Health Care members to submit medical and dental expense reimbursement claims with required documentation.
See template
See template
Member Reimbursement Form For Medical Claims
PDF template
A form for patients to submit medical claims for reimbursement, detailing patient, subscriber, and provider information.
See template
See template
Claims Reimbursement Form
PDF template
A comprehensive form for submitting medical claims for reimbursement, used by patients or healthcare providers to request payment for medical services.
See template
See template
MDHS CLAIM SUPPORT FORM (COST REIMBURSEMENT) PAYMENT TYPE
PDF template
A form used by subgrantees to report monthly costs incurred and request funds on a cost reimbursement basis.
See template
See template
Conference Attendance Report Form
PDF template
Form for classified employees to document conference attendance, learnings, and key insights from professional development events.
See template
See template
Leave Request Form (5 Days)
PDF template
A form for employees to request extended leave of 5 or more days, to be submitted to Human Resources with supporting documentation.
See template
See template
LOWER COLUMBIA COLLEGE CLASSIFIED PPE FOOTWEAR PURCHASE FORM
PDF template
A form for employees to request reimbursement or purchase of personal protective equipment (PPE) footwear up to $200 every two years.
See template
See template
Payroll Deduction Form
PDF template
Form for employees to set up or modify payroll deductions for the Chaffey College Auxiliary Classified Senate account.
See template
See template
Contribution Form Catastrophic Sick Leave Bank
PDF template
A form for classified employees to voluntarily contribute sick leave days to a shared catastrophic leave bank for extreme circumstances.
See template
See template
Classified TransferPromotion Request Form
PDF template
A form for employees of Cutler-Orosi Joint Unified School District to request an internal job transfer or promotion.
See template
See template
CCLLA Classified Leave Application
PDF template
A comprehensive form for employees to request various types of leave, including vacation, sick, FMLA, and flex time adjustments.
See template
See template
Classified Employee Appraisal Process
PDF template
A comprehensive workflow for conducting performance evaluations for Administrative & Professional and Classified Employees at UTRGV.
See template
See template
Account Holder Authorization And Consent Form
PDF template
A consent form allowing the Department of Community Services and Development to share utility account information for energy assistance program evaluation.
See template
See template
FNHA Client Reimbursement Request Form
PDF template
A form for First Nations people in British Columbia to request reimbursement for eligible health benefits and services.
See template
See template
2024 2025 Nomination Of Classified Professional
PDF template
Nomination form for classified professionals to participate in a leadership development program within the Chabot - Las Positas Community College District.
See template
See template
Clothing Purchase Form
PDF template
Form for documenting clothing purchases by State of Wyoming employees, tracking taxable and non-taxable clothing items for IRS reporting purposes.
See template
See template
Requisition
PDF template
A financial document used by clubs or organizations at Virginia Western Community College to request purchases or reimbursements.
See template
See template
REQUEST FOR CMECEU REIMBURSEMENT
PDF template
Form for healthcare professionals to request reimbursement for continuing medical education courses and fees during the 2014 calendar year.
See template
See template
CMLT Pre Travel Form
PDF template
A comprehensive form for documenting travel details, expenses, and reimbursement information for Indiana University travelers.
See template
See template
HEALTH INSURANCE CLAIM FORM
PDF template
Standard medical insurance form for submitting healthcare claims and patient information for reimbursement purposes.
See template
See template
Health Insurance Claim Form
PDF template
Official form for submitting medical insurance claims and capturing patient and insured party information.
See template
See template
Medicare Redetermination Request Form 1st Level Of Appeal
PDF template
Official form for Medicare beneficiaries to request a first-level appeal of a Medicare claim determination.
See template
See template
Medicare Reconsideration Request Form 2nd Level Of Appeal
PDF template
A form for Medicare beneficiaries or providers to request a second-level appeal of a Medicare claim determination.
See template
See template
EFT Authorization Agreement
PDF template
A form for healthcare providers to authorize electronic Medicare payments to their designated bank account.
See template
See template
Privacy Impact Assessment Benefits Coordination And Recovery Center
PDF template
Privacy impact assessment documenting the data collection and processing system for Medicare benefits coordination and recovery processes.
See template
See template
CMSP 215 Supplemental Application
PDF template
Application form for individuals seeking medical services coverage through the County Medical Services Program with rights and responsibilities outlined.
See template
See template
POLICY ON PETTY CASH
PDF template
Guidelines for establishing and maintaining departmental petty cash funds and reimbursing petty cash expenditures at New York Medical College.
See template
See template
Lincolnshire Village Code Administrative Procedure For Public Safety Employee Benefits
PDF template
Establishes administrative procedures for determining eligibility for benefits under the Public Safety Employee Benefits Act in Lincolnshire, Illinois.
See template
See template
Employee Flexible Spending Account (FSA) Enrollment Form
PDF template
Form for employees to enroll in Flexible Spending Account (FSA) options for healthcare and dependent care expenses.
See template
See template
Account Information Tax Advantage Wellness Programs
PDF template
Form for establishing a new account for Tax Advantage Wellness Programs with Colonial Life insurance services.
See template
See template
Employee Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including annual, sick, FMLA, and other leave types, requiring supervisor and HR approval.
See template
See template
Alameda CTC Commissioner Travel And Expenditure Policy
PDF template
Guidelines for travel and expenditure reimbursement for Alameda County Transportation Commission Commissioners during official duties.
See template
See template
Travel Reimbursement Form For Committee Travel
PDF template
A form for Quaker committee members to claim travel expenses for meetings and committee work.
See template
See template
Travel Reimbursement Form For Committee Travel
PDF template
A form for Quaker committee members to claim travel expenses and optionally donate reimbursements back to Canadian Yearly Meeting.
See template
See template
School District Of Philadelphia Community Training Reimbursement Form
PDF template
Form for employees to request reimbursement for educational training expenses and transportation costs within the School District of Philadelphia.
See template
See template
Company Reimbursement Form
PDF template
A form for students with employer tuition reimbursement allowing deferred payment of educational expenses with specific conditions.
See template
See template
Complaint Documentation Form
PDF template
A comprehensive form for documenting and investigating employee complaints, including initial reporting, meeting details, and investigation procedures.
See template
See template
Application Form (Form A) Compost Reimbursement Program
PDF template
Application form for farming and landscaping operations seeking cost reimbursement for compost under Act 302 SLH 2022.
See template
See template
COQUILLE SCHOOL DIST. COMPENSATION PRE AUTHORIZATION
PDF template
A form for employees to request and receive pre-authorization for extra work hours and compensation
See template
See template
CompTIA Certification Exam Reimbursement Form
PDF template
A form for CSU-Pueblo students to request reimbursement for successfully completed CompTIA certification exams through the Center for Cyber Security Education and Research.
See template
See template
CMP 420 04 Business Meals
PDF template
Guidelines for university expenditures on business meals, including cost limits, funding sources, and documentation requirements.
See template
See template
Creating Reports
PDF template
Comprehensive guide for creating expense reports, detailing expense types, naming conventions, and documentation requirements for travel and local expenses.
See template
See template
Conference And Travel Stipend Expense Report
PDF template
Form for scholars to report and document conference and travel expenses funded by the Cooke Foundation.
See template
See template
Conference Attendance Certification Form
PDF template
A form for Huntington Union Free School District employees to document conference attendance for reimbursement purposes.
See template
See template
IEEE Conference Expense Reimbursement Guidelines
PDF template
Guidelines for managing conference-related expenses, payment options, and reimbursement procedures for IEEE conference organizers.
See template
See template
ConferenceTravel Pre Approval Form
PDF template
A form for employees to request pre-approval for conference or travel expenses with detailed cost estimation and reimbursement guidelines.
See template
See template
Confidential Employee Evaluation Process
PDF template
A comprehensive document outlining the performance evaluation procedures and process for employees at Victor Valley Community College District.
See template
See template
CONFIDENTIALSUPERVISORY EMPLOYEES ABSENCE REPORT FORM
PDF template
A form for reporting employee absences, specifically detailing bereavement leave policies for supervisory employees.
See template
See template
Consentimiento Para Recibir Tratamiento, Cesin De Beneficios Y Garanta De Pago
PDF template
A Spanish-language medical consent and insurance benefits assignment form for Northwell Health Dental Medicine patients.
See template
See template
Electronic Consent For W 2 Tax Form And 1095S Health Insurance Offer And Coverage Statement
PDF template
Step-by-step guide for employees to provide electronic consent for receiving W-2 and 1095-C tax and health insurance forms online
See template
See template
ConsultantHonorarium Reimbursement Form
PDF template
A form for documenting consultant payments, honorariums, and reimbursements for research-related services at Old Dominion University Research Foundation.
See template
See template
ConsultantParticipant Expense Reimbursement Form
PDF template
Form for documenting and requesting reimbursement of travel expenses for the State Marine Aquaculture Coordination Network Workshop.
See template
See template
NAIC Funded Consumer Representative Travel Expense Reimbursement Policy
PDF template
Policy detailing travel expense reimbursement procedures for NAIC consumer representatives attending national and interim meetings.
See template
See template
2024 NAIC Funded Consumer Representative Travel Expense Reimbursement Policy
PDF template
Guidelines for reimbursing NAIC consumer representatives' travel expenses for national and interim meetings, with up to $5,500 allocated per representative in 2024.
See template
See template
Federal RetireeS Master Contact List
PDF template
Comprehensive contact list for federal retirees to manage benefits, services, and important resources.
See template
See template
Continuing Education Approval Form
PDF template
Form for library staff to request approval for professional development program expenses and participation.
See template
See template
Determining EmployeeContractor Status
PDF template
A document used to assess and determine the worker classification status for tax and employment purposes.
See template
See template
Contract Details Register
PDF template
Compilation of multiple IT, services, and procurement contracts with details of suppliers, dates, and values.
See template
See template
CONTRIBUTORY PENSIONGRATUITY APPLICATION FORM
PDF template
An official form for individuals applying for contributory pension benefits in Bermuda, to be submitted within 13 weeks of eligibility.
See template
See template
Request For Group Life Conversion Materials
PDF template
Form for obtaining individual life insurance policy after group coverage cessation or reduction
See template
See template
ING Premier Disability Cancellation Form
PDF template
A form for employees to cancel their ING Premier Short Term Disability insurance policy and associated payroll premium deduction.
See template
See template
Time Off Request Form
PDF template
A form for employees to request and track time off hours across two weeks.
See template
See template
COVID 19 Incident Report Form
PDF template
A form to document and track potential COVID-19 exposure and incidents among employees.
See template
See template
Corporate Claim Error Or Reimbursement Application
PDF template
A form for reporting errors or seeking reimbursement for unclaimed funds through the New York State Comptroller's Office.
See template
See template
Corrected (Replacement)Voided Claim Request Form
PDF template
A form used to correct or void previously processed healthcare claims with specific submission requirements.
See template
See template
Corrective And Disciplinary Action Form
PDF template
A formal document used to record workplace misconduct, performance issues, and potential disciplinary actions for employees.
See template
See template
NC State University ReimbursementPCard Expense Approval Form
PDF template
A form for submitting and approving university-related expenses and reimbursements for faculty, staff, and guests.
See template
See template
TRAVEL APPROVAL FORM
PDF template
Comprehensive form for documenting and obtaining approval for employee business travel expenses and trip details.
See template
See template
Employee Counseling Action Form
PDF template
A formal document for documenting employee performance issues, counseling actions, and potential consequences.
See template
See template
County Transportation Requisition Form For County Reimbursement
PDF template
A form used by the Texas Department of Criminal Justice to document and request reimbursement for inmate transportation services.
See template
See template
Course Approval Form And Reimbursement Request Form
PDF template
A form for employees to request approval and potential reimbursement for educational courses or training.
See template
See template
Things To Think About From A Benefits Perspective During The COVID 19 Pandemic
PDF template
A document outlining COVID-19 test reimbursement, free test kit options, and virtual care services for MUSC Health Plan members.
See template
See template
Mennonite Village Covid 19 Earned Leave Request Form
PDF template
A form for employees to request sick or personal days related to COVID-19 circumstances
See template
See template
Emergency Leave Request Form
PDF template
A form for employees to request emergency leave related to COVID-19 circumstances and workplace absences.
See template
See template
COVID 19 Employee Report Form
PDF template
A form for employees to report COVID-19 positive tests or symptoms, used by Wichita State University for tracking and workplace safety purposes.
See template
See template
Paid COVID 19 Leave Request Form
PDF template
A form for Minnesota executive branch employees to request paid leave related to COVID-19 circumstances under Executive Order 20-07.
See template
See template
FFCRA 2021 PAID LEAVE REQUEST FORM
PDF template
Form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) provisions
See template
See template
COVID 19 Leave Request Form
PDF template
Form for Kansas Department of Transportation employees to request leave related to COVID-19 exposure or symptoms
See template
See template
Employee COVID 19 Leave Request Form
PDF template
Form for employees to request leave related to COVID-19 circumstances, including medical diagnosis, quarantine, or childcare needs.
See template
See template
COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave related to COVID-19 situations, including quarantine, illness, and childcare needs.
See template
See template
COVID 19 Leave Request Form
PDF template
Form for employees to request leave related to COVID-19 circumstances, including quarantine, household exposure, and vulnerable health status.
See template
See template
Medical Information Request Form For COVID 19 Temporary Reasonable Accommodation For Faculty, Admini
PDF template
Form for Fordham University employees to request workplace accommodations related to COVID-19 high-risk medical conditions
See template
See template
COVID 19 OTC Test Reimbursement Form
PDF template
Form for submitting reimbursement claims for personally purchased FDA-approved COVID-19 over-the-counter tests.
See template
See template
REQUEST FOR COVID 19 LEAVE
PDF template
A form for Miami-Dade County employees to request paid sick leave related to COVID-19 reasons and circumstances.
See template
See template
Schnucks COVID 19 Pay Plan
PDF template
Policy detailing pay continuance and time off benefits for Schnucks employees during COVID-19 pandemic.
See template
See template
Families First Coronavirus Response Act Emergency Paid Sick Leave Request Form
PDF template
A form for Logan City School District employees to request emergency paid sick leave under the Families First Coronavirus Response Act for COVID-19 related reasons.
See template
See template
WESTFIELD PUBLIC SCHOOLS COVID 19 SICK LEAVE FORM
PDF template
Form for employees to request COVID-19 related sick leave, detailing qualifying reasons for leave under Massachusetts emergency regulations.
See template
See template
COVID 19 SICK LEAVE FORM
PDF template
A form for employees to request COVID-19 related sick leave under Massachusetts temporary emergency regulations.
See template
See template
Request For COVID 19 Employer Paid Leave Of Absence
PDF template
A form for employees to request paid leave related to COVID-19 circumstances including personal illness, vaccination, or childcare needs.
See template
See template
COVID 19 Leave Request
PDF template
A form for employees to request leave due to COVID-19 infection, requiring documentation of a positive test and HR verification.
See template
See template
COVID 19 SUPPLEMENTAL PAID SICK LEAVE REQUEST FORM
PDF template
A form for employees to request supplemental paid sick leave related to COVID-19 vaccination, quarantine, or family care needs.
See template
See template
Creative And Performing Arts Awards (CPA) Expense Reimbursement Form
PDF template
A form for students to submit expenses related to Creative and Performing Arts projects for reimbursement from their college.
See template
See template
KSU Campus Employee Registration Form
PDF template
Registration form for KSU campus employees to request permission to attend a professional education course with supervisory approval.
See template
See template
Inter Office Memorandum RIPTA Price And Product Changes
PDF template
Memo detailing changes to RIPTA transit pass pricing and payroll deduction options for state employees effective March 1, 2016.
See template
See template
Direct Deposit Request
PDF template
A form for employees to set up or cancel direct deposit banking information for payroll purposes.
See template
See template
Juror Attendance Form
PDF template
Form for LANL employees to document and verify jury duty service for payroll purposes.
See template
See template
Payroll Deduction Authorization Zia Credit Union
PDF template
Authorization form for employees to set up, change, or cancel payroll deductions to Zia Credit Union
See template
See template
Credit Card Purchase Form
PDF template
A form for documenting and tracking credit card purchases, requiring details such as purchase date, amount, and event information.
See template
See template
Pinnacle Credit Card Purchase Form
PDF template
A form for documenting and authorizing individual credit card purchases with organizational expense details.
See template
See template
Credit Card Purchase Form
PDF template
Form for submitting and documenting credit card purchases for reimbursement by a Parent-Teacher Organization
See template
See template
MLSA Member Cheque Requisition Form
PDF template
A form for submitting expense reimbursement requests for MLSA members with required documentation and payment details.
See template
See template
Crisis Leave Request Form
PDF template
A form allowing employees to request leave from a Crisis Leave Pool for personal or family health conditions or extraordinary personal crises.
See template
See template
Crisis Leave Request Form
PDF template
A form for employees to request time off through a crisis leave pool for personal or family medical emergencies.
See template
See template
CROSS ACT 2020 TIMESHEET
PDF template
A document for tracking employee work hours, time worked, and payment details for record-keeping and payroll purposes.
See template
See template
CSFA SAFER Award Reimbursement Form
PDF template
Form for volunteer firefighters to request reimbursement for physical exams and personal protective equipment (PPE)
See template
See template
CSFA Reimbursement Form SAFER Award
PDF template
Reimbursement form for volunteer firefighters seeking physical examination and personal protective equipment (PPE) funding.
See template
See template
Flight Attendant Optional Short Term Disability (OSTD)
PDF template
An optional short-term disability insurance program for flight attendants that provides income protection during periods of disability between paid sick time and long-term disability benefits.
See template
See template
CSUCI ALTERNATE WORK SCHEDULE PROGRAM APPROVAL FORM
PDF template
A form documenting employee request and approval for a 9/80 alternative work schedule at California State University Channel Islands.
See template
See template
List Of Items Returned By The Employee
PDF template
A comprehensive form for documenting the return of university-owned equipment and assets by an employee upon separation or leaving the institution.
See template
See template
SEPARATING ATTENDANCE FORM
PDF template
A form used by California State University, San Bernardino for tracking employee separation details and final attendance records.
See template
See template
CTAA Reimbursement Refund Request
PDF template
Process for Utah state and local government agencies to request refunds on tourism assessments for hotel stays under specific conditions.
See template
See template
Commitment To Excellence Award 2024 Nomination Form
PDF template
Award nomination form recognizing outstanding university staff and administrators who demonstrate exceptional commitment and performance.
See template
See template
Employee Performance Evaluation Form
PDF template
Annual performance evaluation documenting goals, objectives, and performance dimensions for an Internal Medicine Account Assistant
See template
See template
Clerical And Technical Performance Feedback
PDF template
A comprehensive form for assessing employee performance across multiple dimensions including communication, customer service, dependability, and technical skills.
See template
See template
CTSO Membership Reimbursement Form
PDF template
Form for requesting reimbursement for Career and Technical Student Organization (CTSO) membership fees for high school chapters in the Western Maricopa Education Center.
See template
See template
SHORT TERM DISABILITY CLAIM FORM
PDF template
Form for employees to file a claim for short-term disability benefits, including personal and employment details.
See template
See template
Dependent Care Reimbursement Form
PDF template
Form for submitting out-of-pocket dependent care expenses for reimbursement through Peak1 benefits program.
See template
See template
Direct Deposit Authorization
PDF template
A form for setting up or changing direct deposit banking information for reimbursement payments.
See template
See template
Payment Request Form
PDF template
A form for requesting payment for self-directed services within a Medicaid waiver program, requiring detailed vendor and service information.
See template
See template
AFSCME LOCAL 3758 EXPENSE REPORT 2020
PDF template
Form for documenting and requesting travel expense reimbursement for AFSCME Local 3758 members.
See template
See template
Custodial Department Time Off Request Form
PDF template
A form for Gundersen Facilities Services employees to request time off for various leave types.
See template
See template
Prescription Claim Form
PDF template
A form for submitting prescription reimbursement claims under a Medicare Part D manufacturer patient assistance program.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, including patient and pharmacy information, insurance details, and claim reasons.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, used to process pharmacy expense reimbursements.
See template
See template
CVS Caremark Prescription Benefits Guide
PDF template
A guide providing six strategies for saving money and time on prescription medications through CVS Caremark's pharmacy benefits program.
See template
See template
Unemployment Insurance Benefits Referral Form
PDF template
A California state form requiring individuals to apply for Unemployment Insurance Benefits before becoming eligible for CalWORKs.
See template
See template
2011 OPSEU Time Off Request Form
PDF template
A comprehensive form for employees to request vacation time during different periods, including prime time summer, non-prime time, and holiday periods.
See template
See template
RCUH Form D 3
PDF template
A comprehensive form documenting employee separation from the Research Corporation of the University of Hawai'i, covering voluntary resignation and involuntary termination details.
See template
See template
Salary AssignmentCancellation (Form D 60)
PDF template
Detailed instructions for completing a salary assignment or cancellation form for University of Hawaii employees
See template
See template
Families First Coronavirus Response Act Leave Request Form
PDF template
Form for Kansas state employees to request leave under FFCRA for COVID-19 related reasons
See template
See template
Dakota Dough Reimbursement Form
PDF template
Form for submitting reimbursement requests for Girl Scout-related expenses and activities.
See template
See template
MEMBER REIMBURSEMENT DENTAL CLAIM FORM
PDF template
A form for members to request reimbursement for out-of-network dental services from their insurance provider.
See template
See template
HR Records Administration Data Verification Request Form
PDF template
A form for collecting comprehensive personal and organizational information for HR record-keeping at the University of Alabama at Birmingham.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for requesting reimbursement from Davis Vision for out-of-network vision services and eyewear expenses.
See template
See template
Juror Request For Day Care Reimbursement
PDF template
A form for jurors to request reimbursement for day care expenses incurred during jury service in the Minnesota Judicial System.
See template
See template
Compensation Policy
PDF template
A comprehensive policy outlining compensation principles, employment classifications, and contractor relationship criteria.
See template
See template
DB 450 Notice And Proof Of Claim For Disability Benefits
PDF template
Instructions for filing a disability benefits claim in New York State, detailing submission requirements and process for employees and recently unemployed individuals.
See template
See template
DBBS Expense Approval Form
PDF template
A comprehensive form for submitting and approving expenses incurred on behalf of DBBS, with detailed policy guidelines and documentation requirements.
See template
See template
New York State Disability Benefits Rights Statement
PDF template
Informational document outlining disability benefits rights for employees in New York State under Section 229 of the Disability and Paid Family Leave Benefits Law.
See template
See template
Appointed Attorney Invoice
PDF template
A form for court-appointed attorneys to submit invoices for legal services rendered in criminal proceedings
See template
See template
APPOINTED ATTORNEY INVOICE
PDF template
A legal form for attorneys appointed to criminal cases to submit billing and reimbursement information to the court.
See template
See template
DCBS Superhero Award Nomination Form
PDF template
A form to nominate DCBS employees for recognition based on exemplary professional qualities and performance.
See template
See template
OVERTIME REQUEST FORM
PDF template
A form for employees to request and receive supervisor approval for overtime work hours.
See template
See template
Title 32 Employee Benefits Part VII Public Employee Deferred Compensation
PDF template
Comprehensive definitions for Louisiana's public employee deferred compensation plan, detailing account balances, administrators, beneficiaries, and related terms.
See template
See template
State Travel Procedures
PDF template
Official directive outlining travel procedures and guidelines for New Jersey Department of Military and Veterans Affairs employees traveling on state business.
See template
See template
DD FORM 1617 Department Of Defense Transportation Agreement
PDF template
Official Department of Defense form establishing government service requirements and transportation allowances for civilian employees transferring outside the continental United States.
See template
See template
DD FORM 1618, DEC 2023
PDF template
A Department of Defense form establishing government time in service requirements for travel and transportation allowances for civilian employees transferring within CONUS.
See template
See template
DD FORM 2656
PDF template
A military form for establishing retired pay accounts, beneficiary designations, and Survivor Benefit Plan elections for military personnel.
See template
See template
DD FORM 2754
PDF template
A form for computing pay entitlements and reimbursements for Junior ROTC Instructors with details about allowances and compensation.
See template
See template
DIRECT DEPOSIT CANCELLATION REQUEST FORM
PDF template
Form for employees to cancel their existing direct deposit banking information for payroll purposes at UNC Greensboro.
See template
See template
Direct Deposit Cancellation Form
PDF template
A form used by employees to cancel their existing direct deposit payroll arrangements with Johns Hopkins institutions.
See template
See template
VA Fiduciary Hub Financial Institution Information Form
PDF template
A document for veterans' fiduciaries to establish or update direct deposit and account titling with the Department of Veterans Affairs.
See template
See template
Affidavit To Request Replacement Of SNAP Benefits
PDF template
Form for requesting replacement of SNAP benefits lost due to household misfortune or electronic benefit theft in Oregon.
See template
See template
Claim For Disability Insurance (DI) Benefits
PDF template
Authorization form for releasing medical information to process a disability insurance claim with the California Employment Development Department (EDD).
See template
See template
EmployeeS Withholding Allowance Certificate (DE 4)
PDF template
A form for employees to specify their state income tax withholding allowances and exemption status for California tax purposes.
See template
See template
Company Reimbursement Form Professional Business Programs
PDF template
A form used by students to document and report employer tuition assistance and support for financial aid purposes.
See template
See template
Employee Incident Investigation Form
PDF template
A formal documentation of an incident involving workplace interactions and potential inappropriate conduct between an employee and her supervisor.
See template
See template
DEATH BENEFIT APPLICATION FORM
PDF template
A form for processing retirement and terminal benefits for deceased retirement savings account (RSA) holders and their next of kin.
See template
See template
Death Benefit Application Form
PDF template
A form for Fiji Bank & Finance Sector Employees Union members to apply for death benefits for themselves or eligible family members.
See template
See template
Debit Card Purchase
PDF template
A form for documenting and tracking debit card expenses for church and parsonage purchases.
See template
See template
PARKING DECAL REFUND REQUEST
PDF template
A form for employees or students to request a refund for parking decals at Southern Illinois University Carbondale under specific conditions.
See template
See template
Declaration Form For Missing Receipts
PDF template
A form used to declare lost or unobtainable expense receipts for travel or business expense reimbursement at the University of Victoria.
See template
See template
Decrease Election Form For Supplemental Life Insurance
PDF template
A form for active state employees to reduce their supplemental life insurance coverage in prescribed increments.
See template
See template
Payroll Deduction Cancellation Form
PDF template
A form allowing employees to cancel specific payroll deductions at Western Michigan University.
See template
See template
Payroll Deduction Cancellation Form
PDF template
Form for employees to cancel various payroll deductions for insurance, benefits, and voluntary contributions.
See template
See template
COMPENSATION AND BENEFITS TRAVEL REIMBURSEMENT
PDF template
Procedures and guidelines for travel expense reimbursement for employees, volunteers, and other individuals traveling on College business.
See template
See template
DEFINED BENEFIT PLAN CHANGE OF ADDRESS FORM
PDF template
A form for SERS members to update their mailing address for retirement benefits communication.
See template
See template
Designated Eligible Individual (DEI) Enrollment Form 2024
PDF template
Form for Michigan Tech employees to enroll a non-spouse individual for health coverage under specific eligibility criteria.
See template
See template
Dental Claim Form
PDF template
A standardized form for submitting dental treatment and insurance claim information to Delta Dental of Illinois.
See template
See template
Delta Dental EnrollmentChange Form
PDF template
A comprehensive form for enrolling in or modifying dental insurance coverage with Delta Dental plans
See template
See template
Delta Dental Of Minnesota Membership Enrollment Form
PDF template
Membership enrollment form for Delta Dental insurance coverage, allowing employees to select dental plan options and enroll dependents.
See template
See template
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS PRESTON LEE DENT V. ROBERT A. MCDONALD
PDF template
Legal document detailing an appeal regarding the overpayment of non-service-connected pension benefits and the effective dates of benefit reduction.
See template
See template
Dental Claim Form
PDF template
Standard form for submitting dental treatment and insurance claim details for reimbursement or predetermination.
See template
See template
ADA Dental Claim Form Instructions
PDF template
Comprehensive instructions for completing the ADA Dental Claim Form, including general instructions, coordination of benefits, and National Provider Identifier requirements.
See template
See template
Delta Dental Of Wisconsin EnrollmentChangeWaiver Form Dental
PDF template
A form for enrolling in, changing, or waiving dental insurance coverage through an employer's group plan with Delta Dental of Wisconsin.
See template
See template
COBRA Dental Insurance EnrollmentWaiver Form
PDF template
A form for employees to enroll in or waive dental insurance coverage, with options for adding or dropping dependent coverage under COBRA.
See template
See template
Dental Insurance EnrollmentWaiver Form
PDF template
A comprehensive form for employees to enroll or waive dental insurance coverage, including personal and dependent information.
See template
See template
Employee Enrollment Form
PDF template
Comprehensive form for employee insurance enrollment with personal information and coverage details.
See template
See template
Dental Insurance EnrollmentChange Form
PDF template
A form for employees to enroll in or modify dental insurance coverage, including dependent information and policy details.
See template
See template
Dental Waiver Form
PDF template
A form allowing civil service staff to waive enrollment in Genesee Community College's group dental insurance plan.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for filing dental insurance claims, collecting patient and insurance information.
See template
See template
DentalVision Enrollment Form
PDF template
Detailed guide for completing a dental and vision insurance enrollment form with step-by-step instructions.
See template
See template
LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave, including medical, personal, and family leave.
See template
See template
LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave, including medical, personal, and family leave.
See template
See template
Health Insurance Enrollment Form
PDF template
A comprehensive form for active employees to enroll in health insurance plans, select medical providers, and manage flexible spending accounts.
See template
See template
DependantS Pension Application Form
PDF template
A form for Nestl European Pension Fund members to nominate a financial dependent to receive pension benefits in the event of the member's death.
See template
See template
Dependent Audit Form
PDF template
A form for employees to verify and update dependent insurance coverage information and personal details.
See template
See template
Dependent And Elder Care Professional Travel Grant Program Reimbursement Form
PDF template
A form for faculty to request reimbursement for dependent care expenses incurred during professional travel.
See template
See template
DEPENDENT CHILD CERTIFICATION
PDF template
Form for certifying dependent child eligibility for Texas Employees Group Benefits Program, with multiple certification options based on child relationship and tax claiming status.
See template
See template
2020 2021 Dependent Student Verification Worksheet
PDF template
A form for collecting detailed information about a dependent student's household and family members for financial aid purposes.
See template
See template
State Of Alaska Payroll Direct Deposit Form
PDF template
A form for Alaska state employees to set up or modify direct deposit arrangements for net pay and flat amount deposits.
See template
See template
Dependent Verification Form
PDF template
A form used to verify a student's independent status by documenting support of a dependent for federal financial aid purposes
See template
See template
Physics And Astronomy Employee Business Expense Reimbursement Form
PDF template
Guidelines for submitting expense reimbursement forms for Physics and Astronomy department employees using a new electronic process through Workday Expenses.
See template
See template
Departmental Software Order Form
PDF template
A form for ordering and tracking software licenses and media for Virginia Polytechnic Institute and State University departments.
See template
See template
Service Credit Purchase
PDF template
A comprehensive guide for Denver employees about purchasing service credit to enhance retirement benefits through the Denver Employees Retirement Plan.
See template
See template
EmployeeS Withholding Certificate For City Of Detroit Income Tax
PDF template
Tax withholding form for employees working in Detroit, used to determine income tax exemptions and work locations.
See template
See template
DHA Form 131, TRICARE Prime Travel BenefitCombat Related Disability Travel Patient Information Works
PDF template
Form for documenting specialty care and non-medical attendant travel requirements for TRICARE Prime enrollees.
See template
See template
DHS 2240 Change Report
PDF template
A form used to report changes in household composition, income, and other key life events within 10 days of occurrence.
See template
See template
UDENYCA Solutions Enrollment Form
PDF template
Enrollment form for patients seeking information about UDENYCA medication and insurance verification services.
See template
See template
Veterans Certification Request (VCR)
PDF template
A form for veterans and military-affiliated students to request educational benefits and certification at Southeastern Louisiana University
See template
See template
Travel ApprovalReimbursement Request
PDF template
A comprehensive form for employees to request and document travel expenses and reimbursement at McLennan Community College.
See template
See template
COPERS Direct Deposit Form
PDF template
A form for Phoenix city employees to set up direct deposit for their pension checks with banking details and authorization.
See template
See template
Direct Deposit Form
PDF template
A form for Navajo Nation employees to set up or modify direct deposit banking information for payroll purposes.
See template
See template
Direct Deposit Authorization And Cancellation Form
PDF template
A form for employees to set up, change, or cancel direct deposit banking information with Kaleida Health.
See template
See template
Payroll Direct Deposit Form
PDF template
Form for employees to set up or modify direct deposit payroll payments at Hope College.
See template
See template
M NCPPC Direct Deposit Form
PDF template
A form for Maryland-National Capital Park and Planning Commission employees to set up or modify direct deposit banking information for payroll.
See template
See template
Direct Deposit Authorization Form
PDF template
Form authorizing automatic deposits and withdrawals to an employee's bank account by The University of the South.
See template
See template
Direct Deposit AgreementDeclination Form
PDF template
A form for authorizing or declining direct deposit payments from the Early Learning Coalition of Brevard County, Inc.
See template
See template
COVA Direct Deposit Form Directions
PDF template
Comprehensive guide for employees completing a direct deposit form, detailing required fields and submission process for the Commonwealth of Virginia payroll system.
See template
See template
COVA Direct Deposit Form Instructions
PDF template
Instructions for completing a direct deposit form for employees, covering required fields and submission guidelines.
See template
See template
Direct Deposit Authorization
PDF template
Form for authorizing electronic deposit of reimbursements into a personal bank account by Employee Benefits Corporation.
See template
See template
Direct Deposit Authorization Manual Claim Reimbursement
PDF template
A form allowing employees to authorize direct deposit of claim reimbursements into a checking or savings account.
See template
See template
Direct Deposit Form
PDF template
A form for employees to set up, modify, or cancel direct deposit of their payroll earnings with their financial institution.
See template
See template
COVA Direct Deposit Form
PDF template
Guidelines for completing a direct deposit form for Commonwealth of Virginia employees, detailing required information and submission process.
See template
See template
COVA Direct Deposit Form Instructions
PDF template
Detailed instructions for employees and agencies completing a direct deposit form for payroll purposes.
See template
See template
CITY OF KAUKAUNA DIRECT DEPOSIT FORM
PDF template
A form for employees to set up direct deposit of their paycheck into one or multiple bank accounts.
See template
See template
Direct Deposit Authorization Form
PDF template
A form allowing employees to authorize direct deposit of their paycheck into one or more bank accounts.
See template
See template
Payroll Direct Deposit Form
PDF template
Form authorizing direct deposit of employee payroll payments for West Virginia University employees
See template
See template
Direct Deposit Authorization Form
PDF template
A form authorizing electronic transmission of payroll funds to an employee's bank account at Widener University.
See template
See template
Hollins UniversityADP Direct Deposit Authorization Form
PDF template
A form for Hollins University employees and students to set up or modify direct deposit banking information for payroll and reimbursements.
See template
See template
Vanderbilt University Direct Deposit Authorization Form
PDF template
A form authorizing Vanderbilt University to deposit payroll funds into specified bank accounts
See template
See template
Direct Deposit Form
PDF template
Form for employees to authorize direct deposit of flexible spending reimbursements through Auxiant.
See template
See template
City Of Austin Employees Retirement System Direct Deposit Form
PDF template
Form for retired City of Austin employees to set up electronic monthly annuity payments to a chosen financial institution.
See template
See template
Authorization For Direct Deposit
PDF template
Form authorizing City of Boise employees to set up direct deposit for wage payments and reimbursements.
See template
See template
Direct Deposit Form
PDF template
A form for employees to set up direct deposit of payroll checks with their employer and financial institution.
See template
See template
Direct Deposit Authorization Form
PDF template
Form for employees to provide banking details for payroll direct deposit at Blue Ridge Community College.
See template
See template
Direct Deposit Employee Authorization Form
PDF template
A form for employees to authorize automatic payroll deposits into bank accounts, including options for new, changed, or additional deposits.
See template
See template
SPLLC Direct Deposit Form
PDF template
Form for employees to provide bank account details for direct deposit of payroll earnings.
See template
See template
EMPLOYEE DIRECT DEPOSIT ENROLLMENT FORM
PDF template
A form allowing employees to set up direct deposit of their paycheck with bank account details and authorization.
See template
See template
Authorization Agreement For Direct Deposits
PDF template
A form allowing employees to set up direct deposit of their paycheck with bank account details and authorization.
See template
See template
Employer Authorization Direct Deposit Form
PDF template
A form allowing employees to authorize direct deposit of their payroll into a bank account at Webster Bank.
See template
See template
Direct Deposit Form
PDF template
A form for employees to set up, change, or cancel direct deposit of their paycheck into a financial institution account.
See template
See template
Direct Deposit Authorization For Automated Deposits (ACH Credits)
PDF template
A form authorizing Trinity University to make direct deposits into a specified bank account and enabling reimbursements, vendor payments, or student payments.
See template
See template
Direct Deposit Authorization
PDF template
A form for employees to set up, modify, or cancel direct deposit banking information for payroll purposes.
See template
See template
Direct Deposit Enrollment Form
PDF template
A form allowing employees to set up direct deposit of their paycheck into bank accounts with authorization and account details.
See template
See template
Authorization For Direct Deposit
PDF template
A form for setting up direct deposit payments with Family Partnerships of Central Florida, detailing account and authorization information.
See template
See template
Authorization For Direct Deposit
PDF template
A form for enrolling in direct deposit reimbursement with Family Partnerships of Central Florida, providing banking details for automatic payments.
See template
See template
Authorization Agreement For Direct Deposit
PDF template
A form for employees to authorize direct deposit of their paycheck into one or more bank accounts.
See template
See template
Payroll Direct Deposit Authorization Form
PDF template
A form for employees to set up or modify direct deposit banking information for payroll at Coquille School District
See template
See template
Electronic Direct Deposit Authorization Agreement For Pre Authorized CreditsDebits
PDF template
A form for employees to authorize electronic direct deposit of payroll funds into their bank account(s)
See template
See template
Direct Deposit Authorization Form
PDF template
A form for employees to authorize electronic paycheck direct deposit into one or more bank accounts.
See template
See template
Payroll Direct Deposit Authorization Form
PDF template
Form for University System of New Hampshire employees to authorize electronic direct deposit of fixed amounts from their paycheck.
See template
See template
Direct Deposit Form For Related Entity Employees
PDF template
A form for employees to provide bank account details for receiving salary payments via direct deposit.
See template
See template
Employee Direct Deposit Authorization Instructions
PDF template
Form for employees to set up automatic paycheck deposits into one or two bank accounts with verification requirements.
See template
See template
Form 61 (Rev July 2021) UNITED ASSOCIATION NATIONAL PENSION FUND DIRECT DEPOSIT AUTHORIZATION FORM
PDF template
Form for authorizing direct deposit of pension fund benefits and providing bank account details for benefit payments.
See template
See template
Direct Deposit Authorization Agreement
PDF template
A form for employees of Natomas Unified School District to set up electronic paycheck deposits into a bank account.
See template
See template
Direct Deposit Form
PDF template
Form for employees to provide bank account details for direct deposit of payroll earnings.
See template
See template
University System Of New Hampshire Payroll Direct Deposit Authorization Form
PDF template
A form for employees to authorize electronic direct deposit of payroll and reimbursement payments by the University System of New Hampshire.
See template
See template
Direct Deposit Application
PDF template
A form for Harnett County employees to set up or modify direct deposit of their paychecks to their chosen financial institution.
See template
See template
Direct Deposit Authorization Form
PDF template
A form for employees to authorize direct deposit of wages to a bank account, with options to start, stop, or change existing direct deposit arrangements.
See template
See template
Direct Deposit And Pay Card Request Form
PDF template
A form for Fulton County employees to select direct deposit or pay card for receiving their payroll funds
See template
See template
Direct Deposit Form
PDF template
Form for employees to provide bank account details for payroll direct deposit, allowing setup of primary and optional secondary accounts.
See template
See template
Direct Deposit Authorization Form
PDF template
Form for authorizing direct deposit of retirement benefits for Alameda County Employees' Retirement Association members.
See template
See template
Self Service Direct Deposit
PDF template
Instructions for employees to set up or modify direct deposit through the Employee Dashboard in Porches/HR system.
See template
See template
Direct Deposit Worksheet
PDF template
A form allowing employees to set up direct deposit for their paycheck with multiple bank account options
See template
See template
Request For Direct Deposit Form
PDF template
A form for employees to set up direct deposit of their payroll funds with Haverhill Public Schools.
See template
See template
Direct Deposit Form Direct Deposit Switch Kit Form
PDF template
A form to authorize direct deposit of payroll or credits into an employee's Abbey Credit Union account
See template
See template
ACHform 2022
PDF template
A form for pension plan members to set up or modify direct deposit banking information for retirement benefits.
See template
See template
Direct Deposit Worksheet
PDF template
Form for employees to set up direct deposit bank information for payroll services with multiple account options.
See template
See template
Direct Deposit Form For NYS Employees
PDF template
A form for New York State employees to set up or modify direct deposit banking information for salary payments.
See template
See template
Directed Quarantine Leave Request Form
PDF template
Form for Philadelphia School District employees to request paid quarantine leave due to COVID-19 exposure or positive test result.
See template
See template
Columbus County Direct Deposit Form
PDF template
Form for employees to authorize direct deposit of payroll funds into their bank accounts.
See template
See template
United Soybean Board Expense Voucher Form
PDF template
Form for submitting travel and expense reimbursement requests for United Soybean Board employees and committee members.
See template
See template
DOTM FORM DAL Request Form
PDF template
A form for employees to request COVID-19-related leave under the Department of Military's Directors Authorized Leave policy.
See template
See template
DIS 101C V7 EMPLOYEE STATEMENT DISABILITY CLAIM FORM
PDF template
A comprehensive form for employees to file a disability claim for short-term or long-term disability benefits.
See template
See template
Disability Allowance To Service Retirement Application
PDF template
A form for CalSTRS members transitioning from disability allowance to service retirement, providing instructions for benefit conversion.
See template
See template
Disability Benefit Application Form
PDF template
Official government form for applying for disability benefits in Bermuda, detailing eligibility requirements for contributory and non-contributory disability benefits.
See template
See template
PSOB Disability Benefits Program Checklist
PDF template
A comprehensive checklist for filing disability claims for public safety officers with the U.S. Department of Justice's PSOB Office.
See template
See template
SUPPLEMENTAL DISABILITY CLAIM FORM
PDF template
Claim form for submitting a disability benefit request for IUOE Local 132 Health and Welfare Fund participants
See template
See template
Group Disability Claim Filing Instructions
PDF template
Instructions for filing a disability insurance claim with American Fidelity Assurance Company, detailing the required steps and documentation.
See template
See template
DISABILITY HEALTH WELFARE HOURS CLAIM FORM
PDF template
A form for participants to claim disability hours and benefits through the Southwest Carpenters Health & Welfare Trust
See template
See template
Disability Coverage Claim Form
PDF template
Insurance claim form for filing a disability coverage claim with American Heritage Life Insurance Company.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for submitting a disability insurance claim, detailing the policyholder's medical condition and disability status.
See template
See template
Delta Pilots Mutual Aid Disability Claim Form
PDF template
Disability claim form for Delta pilots to request benefits and authorize medical information release and payment processing.
See template
See template
Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a claim for short-term disability benefits, requiring input from the employee, employer, and attending physician.
See template
See template
Disability Claim Form Instructions
PDF template
Comprehensive instructions for filing a disability insurance claim with sections for physician, claimant, and employer statements.
See template
See template
New York State NOTICE AND PROOF OF CLAIM FOR DISABILITY BENEFITS
PDF template
Official New York State form for filing a disability benefits claim, to be used by employees who became disabled while employed or within four weeks of employment termination.
See template
See template
MetLife Disability Insurance Guide
PDF template
A comprehensive guide for reporting disability claims and absence procedures through MetLife insurance.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability claim with the Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds.
See template
See template
Supplementary Disability Claim Form
PDF template
A form used to submit disability claims, requiring details from both the claimant and attending physician about an employee's inability to work.
See template
See template
Disability Support Pension Application Form
PDF template
A comprehensive form for individuals seeking financial support due to disability, covering eligibility, evidence requirements, and application process.
See template
See template
SI 11268 Your Disability Benefit Claim
PDF template
Application packet for submitting a long-term disability benefits claim, including instructions for completing required forms.
See template
See template
Disabled Dependent Authorization Form
PDF template
Insurance form for documenting dependent status, eligibility, and coverage details for a disabled dependent under 26 years old.
See template
See template
How To File A Claim For Weekly Disability Benefits
PDF template
Comprehensive guide for filing a disability benefits claim, including required documentation and medical certification requirements.
See template
See template
Disbursement Of Cash Policies
PDF template
Policy outlining cash advance and reimbursement procedures for students and university employees at Xavier University.
See template
See template
Documenting Discipline Issues
PDF template
A comprehensive checklist for managers to properly document employee disciplinary actions and performance issues.
See template
See template
NON UNIFORM EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document recording an employee's demotion and the reasons for disciplinary action.
See template
See template
Waccamaw EOC, Inc. Disciplinary Action Form
PDF template
A formal document used to record and document workplace misconduct and associated disciplinary measures for an employee.
See template
See template
Disciplinary Action Form
PDF template
Official form for documenting employee disciplinary actions, including details of the disciplinary process and required signatures.
See template
See template
Disciplinary Action Form
PDF template
A formal document used to document workplace misconduct, disciplinary actions, and performance issues for an employee.
See template
See template
Disciplinary Action Form
PDF template
A form documenting performance issues and potential disciplinary actions for non-civil service employees.
See template
See template
Payroll Deduction Authorization Form
PDF template
A form allowing FIU employees to authorize payroll deductions for summer camp registration expenses.
See template
See template
DISCRETIONARY EXPENSE APPROVAL FORM
PDF template
A form for employees to request approval of discretionary expenses with detailed category breakdown and multiple levels of authorization.
See template
See template
Cornell University Discretionary Spending Approval Form
PDF template
University form for approving purchases over $50,000, requiring authorization from senior leadership.
See template
See template
Discussion Period Request Form
PDF template
Form for healthcare providers to request a review of a claim determination and provide additional supporting documentation within a 30-day period.
See template
See template
District Reimbursement Form
PDF template
Form for processing reimbursements to a school district for inadvertent charges or other specific expense scenarios.
See template
See template
CLAIM FOR REIMBURSEMENT TRAVEL FORM
PDF template
A form for Coast Guard Auxiliary Division 5 members to claim travel-related expenses and reimbursements.
See template
See template
Diverse Learners Tuition Portability Benefit Frequently Asked Questions
PDF template
A taxable tuition benefit for eligible University of Chicago employees with children attending specific schools in mid-South Side neighborhoods.
See template
See template
Retirement Scheme Divorce Benefit Information Form
PDF template
A form collecting member details for potential benefit distribution in the event of a divorce order affecting a retirement fund
See template
See template
Retirement Scheme Divorce Benefit Information Form
PDF template
A form for collecting member information related to potential benefit distribution in the context of a divorce order
See template
See template
DIY Docs
PDF template
An online legal document creation and storage tool provided by ARAG for employees to generate and manage legal documents independently.
See template
See template
Employee Resignation Form
PDF template
Official form for employees to submit their resignation from College of the Mainland, documenting reasons and effective date of departure.
See template
See template
Employee Resignation Form
PDF template
Official form for employees to submit their resignation from College of the Mainland, documenting reasons and effective date of departure.
See template
See template
PURCHASES REQUIRING DOCUMENTATION OF P CARD PURCHASE FORM
PDF template
Guidelines for documenting purchases that require special justification or explanation when using a purchasing card (P-Card)
See template
See template
Direct Deposit Form
PDF template
Form for employees to set up, change, or cancel direct deposit banking information for payroll at California State University Long Beach Research Foundation.
See template
See template
Direct Deposit Form
PDF template
Form for employees to establish, modify, or cancel direct deposit banking instructions for payroll payments.
See template
See template
Travel Policy
PDF template
Comprehensive policy for standardizing travel authorization, justification, and reimbursement procedures for Department of Health staff, contractors, and volunteers.
See template
See template
COVID 19 Emergency Paid Leave (EPL) Employee Notification And Supplemental Leave Request Form
PDF template
Form for federal employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
See template
See template
Good Fit Domestic Partner Affidavit
PDF template
A form for active and retired employees to add or terminate domestic partner and dependent coverage for various insurance plans.
See template
See template
Affidavit Of Domestic Partnership
PDF template
A legal document establishing the status of domestic partnership for employee benefits and recognition purposes.
See template
See template
DOMESTIC TRAVEL REIMBURSEMENT CLAIM FORM
PDF template
A form for submitting travel-related expenses for reimbursement, including transportation, mileage, and other travel costs.
See template
See template
Donor Leave Request Form
PDF template
A form for employees to request leave for organ, blood, or other donation activities under the Kansas State Donor Program.
See template
See template
DONORRECIPIENT LEAVE REQUEST FORM
PDF template
A form allowing employees to donate personal or medical leave hours to another employee experiencing a catastrophic injury or illness.
See template
See template
Spot Award Nomination Form
PDF template
A form for nominating USC Dornsife employees for a performance recognition award with detailed nomination and eligibility criteria.
See template
See template
DOSBO Student Travel Form
PDF template
Form for University of Georgia students to request travel authorization and potential reimbursement for student organization activities.
See template
See template
Affidavit Of Domestic Partnership
PDF template
Legal document used to verify and document a domestic partnership for employee benefits or organizational recognition.
See template
See template
Disciplinary Action Form
PDF template
A form used to document and submit disciplinary actions for employees within a civil service jurisdiction.
See template
See template
Disability Benefit Application Instructions
PDF template
Comprehensive instructions for submitting a disability benefit application, including eligibility requirements and submission guidelines.
See template
See template
Payroll Deduction Form For Washington State Employees
PDF template
A form for Washington State employees to set up or modify payroll deductions for their DreamAhead college investment account.
See template
See template
Payroll Deduction Guide
PDF template
Comprehensive guide for employees and employers on setting up payroll deductions for the DreamAhead College Investment Plan.
See template
See template
DROP Enrollment Form New Participant
PDF template
A form for qualifying members to enroll in the Municipal Fire and Police Retirement System of Iowa's Deferred Retirement Option Plan.
See template
See template
Drug Free Workplace Act Of 1988
PDF template
Policy prohibiting unlawful manufacture, distribution, dispensing, possession, or use of controlled substances for college employees and students.
See template
See template
LQA Living Quarters Allowance AnnualInterim Expenditures Work Sheet
PDF template
U.S. Department of State form for reporting allowable living quarters expenses to process a claim on SF-1190.
See template
See template
DSB 0311 Employee Administration Request Form
PDF template
Form for managing employee administrative actions for the NC Department of Health and Human Services Division of Services for the Blind.
See template
See template
DSB 0503 Driver Service Billing Form
PDF template
A billing form for recording driver service hours and requesting reimbursement for services provided through the NC Department of Health and Human Services Division of Services for the Blind.
See template
See template
DSB Travel Form
PDF template
A comprehensive travel request form for Defense Science Board personnel to document travel details, reservations, and reimbursement information.
See template
See template
Direct Deposit Enrollment Authorization Form
PDF template
Authorization form for electronic benefit payments through direct deposit for Social Services programs in North Carolina.
See template
See template
Durable Power Of Attorney
PDF template
A form allowing employees to designate an attorney-in-fact to conduct insurance-related transactions with the Employees Group Insurance Division (EGID).
See template
See template
Richmond Retirement System Durable Power Of Attorney Fact Sheet
PDF template
A legal document explaining how Richmond Retirement System members can designate an agent to manage their retirement benefits under specific conditions.
See template
See template
UM Employee Gift Payroll Deduction Form
PDF template
A form allowing University of Michigan employees to authorize charitable donations through payroll deduction.
See template
See template
Employee Benefit Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and vision benefit plans.
See template
See template
Name AndOr Address Change Form
PDF template
Form for employees to request name or address changes within the Central Consolidated School District's HR department.
See template
See template
Employee Academic Tuition Waiver Request Form
PDF template
A form for Cameron University employees to request tuition waivers for themselves or their dependents for academic courses.
See template
See template
View And Update Your Federal Tax Withholding (Form W 4) In Employee Access
PDF template
Instructions for viewing and updating federal tax withholding information online using ADP Employee Access platform.
See template
See template
EAF Contribution Form
PDF template
A form for Camelback employees to voluntarily contribute to the Employee Assistance Fund through payroll deductions.
See template
See template
EagleOne Payroll Deduction Form
PDF template
Form for employees to request payroll deductions for their EagleOne account with specified amount options.
See template
See template
DENTAL APPLICATION AND POLICY CHANGE
PDF template
A comprehensive form for enrolling in or modifying dental insurance coverage, including options for new employees, open enrollment, COBRA, and membership changes.
See template
See template
Claim Form
PDF template
A comprehensive form for submitting claims for various flexible spending and healthcare reimbursement accounts.
See template
See template
Term Life And Disability Income Administration Manual
PDF template
Administration manual for term life and disability insurance benefits for North American Division of Seventh-day Adventists employees.
See template
See template
Fitness Reimbursement
PDF template
A reimbursement program offering $100 for individuals and $200 for families toward qualifying fitness activities.
See template
See template
Travel Policy And Procedures
PDF template
Policy establishing regulations and procedures for travel expenses and reimbursement for employees and authorized persons of the Clerks of Court Operations Corporation.
See template
See template
Reimbursement Form
PDF template
Official form for employees to request travel expense reimbursement from the University of New Mexico (UNM)
See template
See template
Delaware Technical Community College Emergency Contact Form
PDF template
A confidential form for employees to provide emergency contact information for use by authorized personnel in case of an emergency.
See template
See template
Claims Submission Form
PDF template
A form authorizing healthcare providers to submit and exchange personal information for insurance claims processing and benefits administration.
See template
See template
DIRECT DEPOSIT FORM
PDF template
Form for employees to specify bank account details for paycheck direct deposit distribution across up to three accounts.
See template
See template
Employee Declaration Form (EDF) Pay As You Earn (PAYE)
PDF template
Tax declaration form for employees in Mauritius to claim various tax reliefs, deductions, and allowances for the income year 2024-2025.
See template
See template
Harvard Pilgrim Weight Management Reimbursement Form
PDF template
A form for employees to claim reimbursement for weight management program fees through Harvard Pilgrim Health Care.
See template
See template
EDPASSORCA BUS CARD DEDUCTION FORM
PDF template
Form allowing employees to authorize quarterly payroll deductions for bus riding privileges at Edmonds College.
See template
See template
Direct Deposit Authorization Form
PDF template
Form for employees to authorize electronic deposit of benefit reimbursements to a bank account
See template
See template
New York Council Of Nonprofits, Inc. Enrollment Form
PDF template
Enrollment form for Health Care and Dependent Care Flexible Spending Accounts with options for salary reduction and reimbursement methods
See template
See template
FAQs On EFAST2 Electronic Filing System
PDF template
Comprehensive guide providing frequently asked questions about electronic filing of employee benefits forms with the U.S. Department of Labor.
See template
See template
HSA Enrollment Form
PDF template
A form for enrolling in a Health Savings Account through an employer, allowing employees to set up contributions.
See template
See template
American Rescue Plan Act (ARPA) Emergency Family Medical Leave Request Form
PDF template
A form for employees to request extended family medical leave related to COVID-19 under the American Rescue Plan Act.
See template
See template
Emergency Family Medical Leave Request Form
PDF template
Detailed guidance for employees on completing timesheets and tracking Emergency Family and Medical Leave (EFML) usage and compensation.
See template
See template
Power Of Attorney (POA)
PDF template
A form allowing participants or beneficiaries to designate an agent to act on their behalf with the Pension Benefit Guaranty Corporation (PBGC).
See template
See template
Employee Actions EForm
PDF template
Comprehensive electronic form for managing various employee-related actions including hiring, transfers, pay changes, and terminations.
See template
See template
Extended Health Care Claim Form
PDF template
A comprehensive form for submitting medical and health care expense claims to an insurance provider, requiring detailed personal and coverage information.
See template
See template
Parent Invoice Form
PDF template
Monthly transportation reimbursement form for parents transporting children in the Erie County Early Intervention Program
See template
See template
EZ Retirement Plan Enrollment Form
PDF template
Enrollment form for Florida Retirement System employees to choose between Investment and Pension Plan options.
See template
See template
General Retirement Plan Enrollment Form
PDF template
Enrollment form for new employees to choose between retirement plan options in the Florida Retirement System for Regular, Special Risk, and Special Risk Administrative Support Class Employees.
See template
See template
Electronic Communication Authorization Reimbursement Form
PDF template
Form for University of San Francisco employees to request cell phone and data plan subsidies for business use.
See template
See template
Consent Form For Electronic Distribution Of Benefit Materials And Notices
PDF template
A consent form allowing employees to receive electronic copies of benefit materials and notices from Michigan State University.
See template
See template
RapidPayDirect Deposit Authorization Enrollment Form
PDF template
Form for Elmhurst University employees to set up direct deposit or RapidPay! Visa PayCard for receiving wages.
See template
See template
Active Directory And Email Access Request Form
PDF template
Form for requesting and authorizing Active Directory and email system access for faculty, staff, and consultants
See template
See template
Emergency Contact Form
PDF template
A form for employees to list up to four emergency contacts to be used in case of emergencies during work hours or in town buildings.
See template
See template
Emergency Contact Form 32018
PDF template
A form for employees to provide contact information for emergency purposes and primary/secondary emergency contacts.
See template
See template
American Christian Academy Day Care Emergency Contact Form
PDF template
A form for collecting emergency contact information and medical details for children attending American Christian Academy day care.
See template
See template
Employee Emergency Contact Information
PDF template
A form for employees to provide emergency contact details for use in case of urgent situations.
See template
See template
Emergency Contact Information Form
PDF template
A document for collecting employee emergency contact details and medical information for use in urgent situations.
See template
See template
Law Clerk Employee Data And Emergency Contact Form
PDF template
A form for collecting employee personal information and emergency contact details for law clerks in Maryland court system.
See template
See template
Emergency Contact Form
PDF template
A form for employees to provide emergency contact details for workplace safety and communication purposes.
See template
See template
Emergency Contact Information
PDF template
A form for collecting employee emergency contact details and notification preferences for campus safety purposes.
See template
See template
Emergency Coronavirus Paid Leave Request Form
PDF template
Form for City of Birmingham employees to request paid leave related to COVID-19 emergency situations
See template
See template
Emergency Coronavirus Paid Leave Request Form
PDF template
Form for City of Birmingham employees to request emergency paid leave related to COVID-19 pandemic circumstances.
See template
See template
Mennonite Village Covid 19 Earned Leave Request Form
PDF template
A form for employees to request leave due to positive COVID-19 test or related symptoms
See template
See template
Emergency Paid Sick Leave Request Form For COVID 19 Related Leave
PDF template
A form for employees to request emergency paid sick leave related to COVID-19 under the Families First Coronavirus Response Act.
See template
See template
Emergency Paid Sick Leave Act Leave Request Form
PDF template
Employee form for requesting paid sick leave related to COVID-19 under the Emergency Paid Sick Leave Act.
See template
See template
Emergency Paid Sick Leave Request Form
PDF template
A form for employees to request paid sick leave related to COVID-19 under the Emergency Paid Sick Leave Act.
See template
See template
Emergency Paid Sick Leave Request
PDF template
Form for employees to request emergency paid sick leave under the Families First Coronavirus Response Act during the COVID-19 pandemic.
See template
See template
Emergency Paid Sick Leave Request Form
PDF template
Form for employees to request emergency paid sick leave related to COVID-19 circumstances
See template
See template
Reimbursement Claim Form
PDF template
Instructions for submitting healthcare reimbursement claims through multiple methods including Rx debit card, online portal, and paper submission.
See template
See template
Emeriti Retirement Health Solutions Personal Contribution Form
PDF template
A form for making personal contributions to an employer-sponsored retirement health plan managed by TIAA-CREF.
See template
See template
Emeriti Reimbursement Benefit Claim Form
PDF template
Instructions for submitting healthcare reimbursement claims through Rx debit card, online portal, or paper submission.
See template
See template
Emory Card Eagle Dollars Employee Payroll Deduction Form
PDF template
Form for Emory University employees to authorize payroll deductions for Eagle Dollars account
See template
See template
Employee Equipment Loan Agreement
PDF template
A legal document for employees borrowing equipment from James Madison University, outlining responsibilities and conditions of equipment loan.
See template
See template
Health Insurance Claim Form
PDF template
Standard health insurance claim form for submitting patient and insurance information for medical reimbursement and processing.
See template
See template
Employee Agency Account Expense Report Form
PDF template
Form for University of Georgia student organizations to request expense reimbursement from agency accounts for event-related costs.
See template
See template
HR 122 Employee Incident Report
PDF template
A detailed form for documenting workplace incidents and injuries for employees of Biggs Unified School District.
See template
See template
EMPLOYEE ACKNOWLEDGEMENT FORM
PDF template
Form documenting employee understanding of background check requirements under California Assembly Bill 506 of 2021.
See template
See template
Employee Acknowledgement Form
PDF template
A form acknowledging an employee's understanding of background check requirements under California Assembly Bill 506 of 2021.
See template
See template
LIFT WHERE YOU STAND EMPLOYEE GIVING CAMPAIGN 2018 EMPLOYEE PAYROLL DEDUCTION FORM
PDF template
A form for employees to authorize charitable donations through payroll deductions for the annual giving campaign.
See template
See template
Employee Bridge Of Service Review Form
PDF template
A form used to review an employee's service continuity and eligibility for service credit during multiple employment periods.
See template
See template
Employee Change Of Address Form
PDF template
A form for employees to update their address and telephone number with the school district.
See template
See template
BHSSC Employee Change Of Address Form
PDF template
A form for employees to update their personal contact information and address details with their employer.
See template
See template
Complaint Form
PDF template
A form for employees to formally file workplace complaints or request informal resolution of workplace issues.
See template
See template
Employee Complaint Resolution Procedure
PDF template
A formal procedure for resolving work-related employee concerns and complaints within the Technical College System of Georgia, ensuring fair treatment and communication.
See template
See template
Employee Complaint Resolution Form
PDF template
A form for employees to document and submit workplace complaints, detailing issues and requested resolutions.
See template
See template
EMPLOYEE COMPLAINT FORM
PDF template
A comprehensive form for employees to document workplace concerns including discrimination, harassment, ethical, or safety issues.
See template
See template
VR FEE FOR SERVICE PROVIDER EMPLOYEE CONTACT FORM
PDF template
A form for documenting employee details and services for vocational rehabilitation providers
See template
See template
EMPLOYEE CONTRIBUTION FORM
PDF template
A form allowing employees to establish, modify, or continue payroll deductions for foundation donations.
See template
See template
Lamar Community College Foundation Employee Contribution Form
PDF template
A form allowing Lamar Community College employees to make monthly payroll donations to support student programs and college initiatives.
See template
See template
Employee Course Registration Form
PDF template
Form for Gustavus employees to register for courses with tuition benefits, requiring HR and supervisor approvals.
See template
See template
Employee Data Request Form
PDF template
A form for collecting comprehensive employee information to support the electronic appointment process in an organization's human resources workflow.
See template
See template
NHRDeparture Employee Departure Information Sheet
PDF template
A comprehensive guide for faculty and staff leaving their position at the University of Wisconsin Madison, covering benefits, computer access, leave balances, and other departure-related information.
See template
See template
Direct Deposit EnrollmentCancellation Form
PDF template
A form for employees to set up, change, or cancel direct deposit of payroll funds into bank accounts.
See template
See template
EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee workplace violations, warnings, and disciplinary actions.
See template
See template
EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee misconduct, performance issues, or policy violations in the workplace.
See template
See template
Employee Disciplinary Action Form
PDF template
Formal document used to record and document workplace disciplinary actions and violations by employees.
See template
See template
EXTERN EMERGENCY CONTACT FORM
PDF template
Form for collecting emergency contact details for external personnel or employees at a veterinary organization.
See template
See template
EMPLOYEE EMERGENCY CONTACT FORM
PDF template
A form for employees to provide personal and emergency contact details for use in urgent situations.
See template
See template
EMPLOYEE EMERGENCY CONTACT FORM
PDF template
A form for employees to provide emergency contact information for use in case of urgent situations.
See template
See template
EMPLOYEE EMERGENCY CONTACT FORM
PDF template
A comprehensive form for collecting employee personal and emergency contact details for human resources purposes.
See template
See template
Employee Emergency Medical Form
PDF template
Confidential form for collecting employee emergency contact details, medical conditions, and treatment consent.
See template
See template
ENROLLMENT, CHANGE, CANCELLATION, OR OPT OUT EMPLOYEES ONLY HEALTH AND WELFARE PLANS
PDF template
A form for Lawrence Livermore National Security employees to enroll, change, cancel, or opt out of health and welfare benefit plans.
See template
See template
ENROLLMENT FORM FOR GROUP INSURANCE
PDF template
A comprehensive form for enrolling in group insurance benefits, capturing employee and dependent information, coverage selections, and authorization.
See template
See template
Employee Evaluation Form
PDF template
A comprehensive employee performance assessment document with rating scales and sections for job knowledge, work quality, and goal setting.
See template
See template
Employee Evaluation Form
PDF template
A comprehensive form for evaluating employee performance across multiple professional competencies and setting future goals.
See template
See template
Employee Evaluation Form
PDF template
A comprehensive form for evaluating employee performance across multiple skill and competency areas.
See template
See template
STATE OF KANSAS BIDDERS PREFERENCE PROGRAM EMPLOYEE EVALUATION FORM
PDF template
A form for documenting employee background, disabilities, and employment barriers for potential preference program eligibility.
See template
See template
Employee Exit Checklist
PDF template
Comprehensive form documenting employee departure procedures, including credential return, benefits termination, and administrative tasks.
See template
See template
Employee Exit Checklist Form
PDF template
A comprehensive form for managing employee separation process, ensuring return of district property and proper administrative procedures.
See template
See template
Employee SeparationTransfer Checklist
PDF template
A comprehensive checklist for supervisors to manage employee departures or transfers, including access revocation and administrative procedures.
See template
See template
Employee Expense Approval Form
PDF template
A form for employees to document and request reimbursement for travel-related expenses within 30 days of occurrence.
See template
See template
Employee Travel Expense Report Form
PDF template
Form for documenting and requesting reimbursement of employee travel-related expenses by Claremore Public Schools.
See template
See template
EMPLOYEE FEEDBACK FORM
PDF template
A comprehensive form for evaluating employee performance, identifying strengths, development needs, and creating an action plan for professional growth.
See template
See template
Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for Health Savings Account contributions with annual contribution limits and details.
See template
See template
Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for Health Savings Account contributions with annual contribution limits and employer details.
See template
See template
Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for their Health Savings Account contributions with contribution limit details.
See template
See template
Employee Information Change Form
PDF template
A form for employees to update their personal contact information with their employer's human resources department.
See template
See template
Employee Information Form
PDF template
A comprehensive form for collecting personal, contact, demographic, veteran status, and educational background information for new employees.
See template
See template
Employee Injury Report Form
PDF template
A form for documenting employee workplace injuries, incidents, and medical treatment details for workplace safety and insurance purposes.
See template
See template
Employee Inquiry Form
PDF template
A form used by employees to submit inquiries to the Human Resource Services department at Newark Public Schools.
See template
See template
Employee Internal Complaint Intake Form
PDF template
A form for reporting policy violations and discrimination complaints at St. Mary's College of Maryland.
See template
See template
Record Of Employee Interview
PDF template
Confidential document for interviewing construction workers to verify employment details and compliance with labor standards.
See template
See template
Employee Inventions Act
PDF template
Legal document governing employee inventions, service inventions, and technical improvement proposals in employment contexts.
See template
See template
Warner Pacific University Employee Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including FMLA and OFLA leave options
See template
See template
Group Term Life Employee Enrollment Form
PDF template
Insurance enrollment form for employees to select group term life coverage options and designate beneficiaries.
See template
See template
MealFood Pre Approval Form
PDF template
Form for documenting and obtaining approval for business meals and food purchases by university employees
See template
See template
Employee Parking Policy
PDF template
Policy establishing parking provisions and regulations for county employees using county parking facilities and lots.
See template
See template
Employee Of The Month Nomination Form
PDF template
A form for nominating employees in specific job categories for a monthly recognition award within an educational institution.
See template
See template
Facilities And Campus Services Employees Of The Quarter Nomination Form
PDF template
A form for nominating exceptional employees or teams in the Facilities and Campus Services department who demonstrate outstanding performance and organizational values.
See template
See template
Virginia Tech Employee Software Sales Order Form
PDF template
Order form for Virginia Tech employees to purchase software and technology accessories at discounted rates.
See template
See template
Employee Paid And Unpaid Time Off Request Form
PDF template
A form for employees to request paid or unpaid time off, requiring approval from their supervisor.
See template
See template
Employee Paid And Unpaid Time Off Request Form
PDF template
A form for employees to request paid or unpaid time off, requiring supervisor approval and documentation.
See template
See template
EMPLOYEE PAYMENT AGREEMENT FORM
PDF template
A form for documenting an employee's payment schedule and financial obligations to an organization.
See template
See template
Employee Payroll Deduction Form For Full Time Employees And Staff
PDF template
Form allowing employees to set up monthly charitable contributions through payroll deduction to Missouri State University Foundation
See template
See template
Current Lincoln University Employee Payroll Deduction Form
PDF template
Form for Lincoln University employees to set up recurring payroll donations to the Lincoln University Foundation of PA
See template
See template
UAB GIFT RECORDS EMPLOYEE PAYROLL DEDUCTION FORM
PDF template
A form for UAB employees to authorize automatic payroll deductions for charitable contributions to specific funds or programs.
See template
See template
Employee Contribution And Payroll Deduction Form
PDF template
A form for employees to specify contribution amounts, payment methods, and recognition preferences for donations.
See template
See template
Employee Contribution Form
PDF template
A form allowing employees to make charitable contributions through automatic payroll deductions to support Great Basin College scholarships and programs.
See template
See template
Employee Payroll Deduction Form
PDF template
A payroll deduction authorization form for employees to contribute to the Germanna Community College Educational Foundation
See template
See template
Staff Appraisal
PDF template
A comprehensive employee performance review document for documenting and evaluating staff performance, goals, and development
See template
See template
Employee Performance Evaluation Form
PDF template
A comprehensive performance evaluation form for assessing employee job performance, development, and potential promotion opportunities.
See template
See template
Request For Prescription Delivery
PDF template
A form for employees to request prescription delivery with patient and delivery details.
See template
See template
Travel Policy
PDF template
Guidelines for travel expenses and reimbursement for Metro employees, officials, and authorized travelers, focusing on cost-effectiveness and accountability.
See template
See template
Employee Profile And Travel Form
PDF template
A comprehensive form for employees to update personal information, marital status, and travel privileges for family members.
See template
See template
Employee Progress Performance Review
PDF template
A comprehensive employee performance review document for rating job performance, skills, and goal achievement.
See template
See template
Employee Purchase Form
PDF template
A form allowing employees to purchase items and choose payment methods, including payroll deduction and credit card options.
See template
See template
Employee Referral Form
PDF template
Form for employees to refer potential job candidates to Albert Einstein College of Medicine with guidelines for referral awards.
See template
See template
Employee Referral Form
PDF template
A form for employees to refer potential candidates and participate in the company's referral bonus program.
See template
See template
Employee Referral Program Referral Form
PDF template
A form for employees to refer potential job candidates to open positions within the organization.
See template
See template
Employer Reimbursement Payment Plan Application
PDF template
A form allowing students to defer tuition payments based on anticipated employer reimbursement with specific payment terms and conditions.
See template
See template
Employee Resignation Form
PDF template
Official form for employees to submit their resignation from Jackson County Public Schools, detailing reasons for leaving and effective date.
See template
See template
Employee Resource Document
PDF template
A comprehensive guide for University of Scranton employees detailing emergency contacts, campus resources, and essential operational information.
See template
See template
Employee Retirement Contribution Form
PDF template
Form for employees to start, change, or suspend retirement plan contributions at Mountainland Technical College.
See template
See template
Employee Performance Review Form
PDF template
A comprehensive form for assessing employee performance across multiple competency and behavioral dimensions with rating scales.
See template
See template
M NCPPC Benefits EnrollmentChange Form
PDF template
Form for employees to enroll in or modify benefits, including medical, dental, and prescription plans.
See template
See template
Employee Self Assessment Form
PDF template
A comprehensive self-evaluation form for employees to reflect on their job performance, achievements, and goals.
See template
See template
Employee Self Service Guide
PDF template
Comprehensive guide for navigating the Employee Self Service (ESS) portal and accessing various employee-related resources and information.
See template
See template
Form 43 Employee TransferSeparation Clearance Form
PDF template
A form used to document and track the clearance process for employees transferring departments or separating from the university.
See template
See template
HR64 Employee Separation Checklist
PDF template
A comprehensive form documenting the process and requirements for an employee's exit from the organization, including equipment return and account deactivation.
See template
See template
Employee Services FAQ Contact List
PDF template
A comprehensive contact reference for employees covering various HR topics, benefits, and service inquiries.
See template
See template
Employee Status Requisition
PDF template
A document used to initiate and document changes in employee status within an organization's human resources processes.
See template
See template
Employee Time Off Request
PDF template
A form for employees to request time off for various reasons, requiring supervisor approval.
See template
See template
Employee Time Off Request Form
PDF template
A form for personal care assistants (PCAs) to request paid or unpaid time off, with requirements for submission and approval.
See template
See template
Employee Time Off Request Form
PDF template
A form for employees to request time off, specifying type and duration of leave and requiring manager approval.
See template
See template
Employee (StudentStaff) Timesheet
PDF template
A comprehensive timesheet form for tracking employee work hours across multiple weeks and shifts with absence code tracking.
See template
See template
Roosevelt University Travel And Business Expense Policy
PDF template
A comprehensive policy governing travel and business expense reimbursement for Roosevelt University faculty, staff, and students conducting official university business.
See template
See template
Employee Tuition Benefit Application
PDF template
Application form for permanent employees to receive tuition waiver for themselves or eligible dependents at Lethbridge College.
See template
See template
Employee And Dependent Tuition WaiverReimbursement Form
PDF template
Form for employees to request tuition waiver or reimbursement for themselves or dependents at SSU.
See template
See template
Eye Care Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in or modify eye care insurance coverage for themselves and dependents.
See template
See template
Health Coverage Waiver Form
PDF template
A document allowing employees to waive health insurance coverage offered by their employer with options for alternative coverage.
See template
See template
Disciplinary Action Form
PDF template
A formal document used to record and document employee misconduct, policy violations, and disciplinary actions.
See template
See template
Employee Write Up Forms Packet
PDF template
Comprehensive packet of forms for documenting employee workplace issues, complaints, and disciplinary actions.
See template
See template
Employer Error Institution Process
PDF template
Guidelines for handling employer errors in employee insurance enrollment, detailing steps for institutions and employees to correct coverage issues.
See template
See template
2023 2024 Employer Reimbursement Form
PDF template
A form for students receiving employer tuition reimbursement, detailing financial responsibilities and payment terms at Walsh University.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A form for submitting out-of-network vision service claims with instructions for online or mail submission.
See template
See template
Windfall Elimination Provision
PDF template
Explanation of how Social Security retirement or disability benefits may be reduced for workers with pensions from employers not withholding Social Security taxes.
See template
See template
How To File A Disability Appeal Online
PDF template
Step-by-step instructions for filing a disability appeal online with the Social Security Administration
See template
See template
Adult Disability Starter Kit
PDF template
A comprehensive checklist to help applicants prepare for filing a Social Security disability benefits claim by organizing personal, medical, and employment information.
See template
See template
Authorization And Consent To Treatment
PDF template
A comprehensive document outlining patient consent for medical treatment, insurance benefits assignment, and payment responsibilities.
See template
See template
Member Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service expenses to Anthem Blue Cross insurance
See template
See template
Contribution Form
PDF template
A form for employees to make voluntary donations to the Enhabit Cares Foundation through payroll deduction, check, or credit card.
See template
See template
Enhanced Dental Benefits Enrollment Form
PDF template
A self-enrollment form for additional dental coverage for members with specific medical conditions through Blue Cross Blue Shield of Massachusetts.
See template
See template
Northern California Carpenter Funds Enrollment Form
PDF template
Form for enrolling or updating records with the Northern California Carpenter Funds, including health plan selection and participant information.
See template
See template
Vision Service Plan EnrollmentChange Form
PDF template
Form for employees of Fallbrook Elementary School District to enroll or modify vision insurance coverage for themselves and dependents.
See template
See template
Superior Dental Care Employee Enrollment Form
PDF template
Form for employees to enroll in dental and vision insurance benefits through Superior Dental Care.
See template
See template
ENROLLMENT FORM GL.2017.010
PDF template
A comprehensive employee insurance enrollment form for selecting life and AD&D coverage options for employees and dependents.
See template
See template
NEA Membership Enrollment Form CCA
PDF template
Enrollment form for teachers to join the National Education Association, California Teachers Association, and local education unions.
See template
See template
California State University, Sacramento Benefit Enrollment Worksheet
PDF template
A form for employees to complete transactions affecting health, dental, vision, and FlexCash coverage at California State University, Sacramento.
See template
See template
City Of Albany 457 Deferred Compensation Plan Enrollment And Contribution Form
PDF template
A form for City of Albany employees to enroll in or modify contributions to their 457 Deferred Compensation Plan at MissionSquare Retirement.
See template
See template
ENROLLMENT FORM NATIONAL ELEVATOR INDUSTRY BENEFIT PLANS
PDF template
An enrollment form for employees of the National Elevator Industry to enroll in benefit plans and update personal and dependent information.
See template
See template
Entertainment Expense Approval Form
PDF template
Form for requesting and approving university-related entertainment expenses with detailed documentation requirements.
See template
See template
Entertainment Of University Guests And Employees
PDF template
Policy governing entertainment expenses for university guests and employees, including guidelines for business-related entertainment and reimbursement procedures.
See template
See template
PASC UCSB Business Meeting And Entertainment Reimbursement Form
PDF template
Form for requesting reimbursement of business-related meal and entertainment expenses at University of California, Santa Barbara.
See template
See template
Employee Organization Leave Request And Reimbursement Form
PDF template
A form for public employees to request organization leave and reimbursement for specific meetings and circumstances.
See template
See template
Employee Of The Month Nomination Form
PDF template
A form for nominating Jackson County employees for monthly recognition with specific eligibility criteria and rewards.
See template
See template
Transfer Request Form
PDF template
A form for students transferring between colleges and seeking Extended Opportunity Programs and Services (EOPS) continuity.
See template
See template
Employer Of Record Time Sheet
PDF template
A timesheet form for tracking employee hours and services, particularly for respite care services.
See template
See template
EPAR Timesheet
PDF template
A standard timesheet form for tracking employee work hours and payroll information.
See template
See template
EPC Requisition Form
PDF template
A financial form for requesting payments or reimbursements within a church ministry budget across various ministry categories.
See template
See template
TIME OFF REQUEST FORM
PDF template
A form for employees to request vacation, sick, personal, or flex time with specific instructions and approval process.
See template
See template
OMNI EPerformance Training AP EPerformance Quick Reference Supervisor And Employee Actions
PDF template
A step-by-step guide for supervisors and employees using the ePerformance evaluation system for performance reviews.
See template
See template
Nomination And Declaration Form For Unexempted Exempted Establishments
PDF template
A form for employees to nominate beneficiaries for provident fund and pension scheme benefits in case of death.
See template
See template
Employer Pension Guide
PDF template
Comprehensive guide for rejoining employees about pension scheme options and eligibility criteria in the Principal Civil Service Pension Scheme (PCSPS).
See template
See template
COVID 19 Emergency Paid Leave (EPL) Employee Notification And Leave Request Form
PDF template
Form for employees to request emergency paid leave related to COVID-19 circumstances and qualifying conditions
See template
See template
EPOC Invoice Template
PDF template
Instructions and template for submitting quarterly invoices for the Expanding Peer Organizational Capacity (EPOC) program by Advocates For Human Potential, Inc.
See template
See template
Kenyon College Employee Performance Program Guide For Supervisors
PDF template
A comprehensive guide outlining Kenyon College's performance management process, including quarterly check-ins and triennial performance reviews.
See template
See template
Equipment And Personal Items Inventory Form
PDF template
A form used to document institutional assets and personal items being returned by an employee during separation from UT Health San Antonio.
See template
See template
Expense Report Form
PDF template
A comprehensive financial reporting form for tracking program and administrative expenses for Communities In Schools of Wake County.
See template
See template
ERCS Kudos Corner Submission Form
PDF template
A form for employees to recognize and nominate colleagues for outstanding work in a monthly newsletter feature.
See template
See template
College Of The Siskiyous Emergency Contact Form
PDF template
A form for collecting employee emergency contact information and contact preferences for information release.
See template
See template
Employee Resource Document
PDF template
A comprehensive resource document for employees providing emergency contacts, academic information, and campus resources.
See template
See template
Retirement Checklist
PDF template
A comprehensive checklist for members preparing to retire, outlining key steps and document requirements one year before retirement.
See template
See template
Employer Reimbursement Payment Agreement
PDF template
An agreement allowing students to defer tuition payment based on anticipated employer reimbursement for educational expenses.
See template
See template
ElectricianS Retirement Fund Benefit Application Packet
PDF template
An application packet for pension benefits from the Electrician's Retirement Fund, providing instructions for submitting retirement documentation.
See template
See template
Emergency Ride Home (ERH) Reimbursement Form
PDF template
Form for employees to request reimbursement for emergency transportation home under specific qualifying circumstances.
See template
See template
NEW UPDATE IMPORTANT PAYROLL INFORMATION FOR ALL FACULTY AND STAFF
PDF template
Notification about the new PeopleSoft payroll system requiring all employees to submit time and leave requests electronically, eliminating traditional timecards and leave forms.
See template
See template
RETIREE INSURANCE ENROLLMENT FORM
PDF template
A form for Texas Employees Retirement System retirees to enroll in insurance and provide Medicare information
See template
See template
ES 4316 EES InterviewScreen
PDF template
A screening form to evaluate employee eligibility for intervention services based on multiple risk factors
See template
See template
ESA 1126A FORFFA Cancellation Of Direct Deposit
PDF template
Official form for cancelling direct deposit for unemployment insurance benefits in Arizona
See template
See template
TRAVEL REIMBURSEMENT FORM
PDF template
Form for employees or vendors to document and request reimbursement for travel-related expenses including conference, transportation, lodging, and meals.
See template
See template
Payroll Deduction Authorization Form For Panther Employee ScholarshipWaiver Program
PDF template
Authorization form for Prairie View A&M University employees to have tuition and fees deducted directly from their paycheck
See template
See template
ESP Performance Review
PDF template
A comprehensive evaluation form for assessing employee performance across multiple job characteristics and skills.
See template
See template
Vehicle Registration Form
PDF template
A form for registering vehicles for employees at Vassar College, used to track campus parking and vehicle information.
See template
See template
EMPLOYEE TIME OFF REQUEST FORM
PDF template
A form for employees to request various types of time off, including sick leave, vacation, and bereavement
See template
See template
Carter County PERSONNEL PERFORMANCE REVIEW FORM
PDF template
A comprehensive form for evaluating employee performance across multiple job competency categories.
See template
See template
SBA Event Participation Form
PDF template
A form for documenting participant details and expenses for an SBA event with required documentation for reimbursement.
See template
See template
Event Expense Reimbursement Form
PDF template
Form for reimbursing event expenses for approved sporting events at fire stations, with a $500 annual benefit maximum.
See template
See template
CY 2025 TITLE IV E REIMBURSEMENT FOR COUNTY EWiSACWIS COSTS
PDF template
Guidelines for preparing budget forms and time reports for Title IV-E reimbursement of county eWiSACWIS system costs for calendar year 2025.
See template
See template
Child Care For PCS Family Child Care Provider Billing Form
PDF template
Billing form for family child care providers supporting Air Force members during Permanent Change of Station (PCS) moves.
See template
See template
MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
PDF template
A comprehensive medical insurance claim form for submitting healthcare reimbursement or coverage information.
See template
See template
SilverFit Out Of Network Reimbursement Form
PDF template
A form for members to request reimbursement for out-of-network fitness facility expenses under the Silver&Fit program.
See template
See template
Exceptional Travel Expense Approval Form For UC Berkeley Faculty And Staff
PDF template
A form for obtaining pre-approval and documenting special circumstances for travel expenses for UC Berkeley faculty and staff.
See template
See template
Board Member Estimated Expense Approval Form
PDF template
A form for board members to request pre-approval of travel and expense reimbursements, including grant-related travel expenses.
See template
See template
University Of South Alabama Athletic Team Travel Reimbursement Form
PDF template
A form for University of South Alabama athletic team members to document and request reimbursement for travel-related expenses.
See template
See template
EXIT CHECKLIST
PDF template
A comprehensive form for employees to complete when leaving their position, covering key administrative and logistical tasks during the exit process.
See template
See template
EMPLOYEE CLEARANCE CHECK LIST
PDF template
A comprehensive form for documenting an employee's departure from an organization, covering departmental clearance and separation details.
See template
See template
Sick Leave Contribution Form
PDF template
A form allowing Stephen F. Austin State University employees to voluntarily donate sick leave or vacation leave to sick leave or family leave pools upon separation or while active.
See template
See template
Stephen F. Austin State University ADDRESSNAME CHANGE FORM
PDF template
A form for university employees to update personal information including name, address, and contact details.
See template
See template
EXIT INTERVIEW FORM
PDF template
A comprehensive form tracking an employee's departure process, including benefits, equipment return, and final payroll details.
See template
See template
TRAVEL ADVANCE EXPENSE REPORT REQUISITION CHECK REQUEST
PDF template
A multi-purpose document for requesting travel advances, submitting expense reports, placing requisitions, and requesting checks for various organizational expenses.
See template
See template
Expense Reimbursement Form For Non SMCCCD Employees
PDF template
Form for reimbursing expenses for non-SMCCCD employees participating in SMCCCD-related events with required documentation.
See template
See template
SEMA4 EMPLOYEE EXPENSE REPORT
PDF template
A form for employees to document and request reimbursement for travel-related expenses and mileage.
See template
See template
Expense Report Form
PDF template
A form for submitting and approving expense reimbursements for Cary Chinese School's organizational expenses
See template
See template
Expense Reporting Form
PDF template
A comprehensive form for documenting and requesting various types of non-standard expense reimbursements and payments at an educational institution.
See template
See template
Expense Reimbursement Policy
PDF template
Policy detailing expense reimbursement guidelines for Society of Toxicology members traveling on official business.
See template
See template
Travel And Business Related Expense Policy
PDF template
Policy governing travel and business-related expense reimbursement for volunteers and non-employees of the State Bar of California.
See template
See template
Expense Reimbursement Form
PDF template
A form for advisers to submit travel and meeting-related expense reimbursement requests from the American Law Institute (ALI).
See template
See template
Expense Reimbursement Form
PDF template
A form used for submitting and tracking expense reimbursement requests for the Secretary of State's office.
See template
See template
Expense Reimbursement Form
PDF template
Official form for submitting and tracking expense reimbursements for the Louisiana Secretary of State's office.
See template
See template
Policy Council Expense Reimbursement Form
PDF template
A comprehensive form for reimbursing Policy Council members for mileage, child care, meeting participation, and other expenses.
See template
See template
Expense Reimbursement Form Non Travel
PDF template
Form for employees to request non-travel related expense reimbursement from the College of Science at UTSA
See template
See template
Student Expense Reimbursement Process
PDF template
Detailed instructions for students to submit expense reimbursement forms, including required documentation and submission process.
See template
See template
EXPENSE REIMBURSEMENT POLICY
PDF template
Policy outlining expense reimbursement rules and procedures for ADSA volunteers, including acceptable expenses, documentation requirements, and travel guidelines.
See template
See template
EXPENSE REIMBURSEMENT PROCEDURES
PDF template
Comprehensive guidelines for employee expense reimbursement covering business expenses and travel, aligned with IRS accountable plan regulations.
See template
See template
SEMA4 Employee Expense Report
PDF template
A comprehensive form for employees to report travel expenses, mileage, and other reimbursable costs for business trips.
See template
See template
TEST ADMINISTRATORS EXPENSE REPORT FORM
PDF template
Form for test administrators to report and request reimbursement for expenses related to exam administration.
See template
See template
Expense Report
PDF template
A comprehensive form for employees to document and request reimbursement for work-related expenses including travel, meals, and other costs.
See template
See template
EXPENSE REPORT
PDF template
A form for employees to report and request reimbursement for work-related expenses, including travel and miscellaneous costs.
See template
See template
Expense Report Form 2024
PDF template
A detailed form for employees to report and request reimbursement for work-related expenses including mileage, conference costs, and supplies.
See template
See template
Expense Report Form
PDF template
A form for submitting expense reimbursement requests for organizational expenses within a council structure.
See template
See template
Judging Accreditation Test Administrators Expense Report Form
PDF template
Form for USA Gymnastics test administrators to report expenses and honorarium for exam administration.
See template
See template
Expense Report
PDF template
A form for submitting and tracking out-of-pocket expenses for Idaho State Bar volunteers and committee members
See template
See template
Bah Center Treasury Event Expense Form
PDF template
A form for submitting and tracking event-related expenses for reimbursement by the Bah' Center Treasury.
See template
See template
SEMA4 Employee Expense Report
PDF template
A detailed form for documenting employee travel expenses, mileage reimbursement, and other related costs.
See template
See template
Out Of Pocket Expense And Reimbursement Guidelines
PDF template
Guidelines for University employees and non-employees to seek reimbursement for out-of-pocket expenses using the Concur Expense System.
See template
See template
Expense Report Instructions
PDF template
Comprehensive instructions for completing and submitting an expense report for employee travel and business expenses at WPI.
See template
See template
Mid Michigan Section SAE Expense Report Form
PDF template
A form for reporting and submitting expenses with receipt documentation for reimbursement.
See template
See template
Payroll Deduction Authorization Form
PDF template
Form for Florida International University (FIU) employees to authorize payroll deductions for summer camp registration and related services.
See template
See template
Express Benefit Report
PDF template
A form used to report accumulated unused sick leave balances and employment termination information for CalSTRS retirement benefits.
See template
See template
EXTENDED LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request extended leave, including details about leave type, duration, and supporting documentation.
See template
See template
Texas City ISD Extended Leave Request Form
PDF template
A form for employees to request extended leave with medical certification, to be submitted to Human Resources.
See template
See template
Extended Workshop Handout Reimbursement Form
PDF template
Form for workshop chairs to claim up to $100 reimbursement for workshop material copies.
See template
See template
Eyeglass Reimbursement Form
PDF template
A form for employees to request reimbursement for eyeglass purchases through the school district's benefits program.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A claim form for submitting out-of-network vision services reimbursement to First American Administrators for EyeMed Vision Care plans.
See template
See template
EnrollmentChange Form
PDF template
A form for enrolling or changing employee and family insurance coverage with Fidelity Security Life Insurance Company.
See template
See template
EnrollmentChange Form
PDF template
Insurance enrollment and change form for employees and their family members, underwritten by Fidelity Security Life Insurance Company.
See template
See template
Out Of Network Claim Form
PDF template
A form for EyeMed Vision Care members to submit claims for out-of-network vision care services and receive reimbursement.
See template
See template
CCP Prior Authorization Request Form
PDF template
A form for healthcare providers to submit prior authorization requests for medical services or treatments through Texas Medicaid Health and Human Services.
See template
See template
Direct Deposit Request Form
PDF template
Form for employees to request direct deposit of paycheck into bank account(s)
See template
See template
Employer Health Insurance Verification Individual Follow Up Health Insurance Information
PDF template
A form for employers to verify health insurance benefits offered to employees and their families for BadgerCare Plus applicants.
See template
See template
Change Of Address Form Benefit Recipient
PDF template
A form for benefit recipients to update their mailing address with the Massachusetts Teachers' Retirement System (MTRS)
See template
See template
Change Of Address Form
PDF template
A form for members to update their mailing address for various trust fund communications and services.
See template
See template
Wisconsin Medicaid Services Application
PDF template
Wisconsin state application form for Medicaid services, including applicant and spouse information, income details, and eligibility questions.
See template
See template
Medicaid Asset Assessment
PDF template
A form to evaluate the total assets owned by a Medicaid applicant and their spouse to determine eligibility for Medicaid benefits.
See template
See template
PDP Prescription Reimbursement Request Form
PDF template
A form for members to request reimbursement for prescription medications purchased at retail cost when standard prescription drug coverage was not used.
See template
See template
Medical Dental Time Loss Claim Form
PDF template
A comprehensive medical claim form for employees and dependents to submit healthcare and time loss claims.
See template
See template
F245 145 000 Travel Reimbursement Request
PDF template
A form for workers to request travel expense reimbursement related to workers' compensation medical visits, treatments, or vocational services.
See template
See template
Puget Sound Benefits Trust Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a short-term disability claim, requiring details from the employee, employer, and attending physician.
See template
See template
NW Plumbers Pipefitters Health Fund Change Of Address Form
PDF template
A form for updating personal contact information for members of the NW Plumbers & Pipefitters Health Fund
See template
See template
Medical Dental Vision Prescription Weekly Disability Claim Form
PDF template
Comprehensive claim form for medical, dental, vision, prescription, and weekly disability benefits for NW Plumbers & Pipefitters Health Fund members.
See template
See template
Change Of Address Form
PDF template
A form for employees to update their contact information with the Puget Sound Electrical Workers Trust Funds.
See template
See template
Enrollment Form F33
PDF template
Comprehensive enrollment form for employees to register dependents and update personal information for benefit plans
See template
See template
Disability Claim Form
PDF template
A comprehensive form for submitting a disability insurance claim, covering coverage information, work schedule, and earnings details.
See template
See template
Change Of Address Form
PDF template
A form for union members to update their contact information with the trust funds administration office.
See template
See template
Form WT 4A Worksheet For Employee Withholding Agreement
PDF template
A worksheet for employees to adjust their income tax withholding for 2015 in Wisconsin based on estimated tax liability.
See template
See template
Change Of Address Form
PDF template
A form for employees to update their personal contact information with the Engineers-AGC Retirement Trust
See template
See template
Change Of Address Form
PDF template
A form for members of Steamfitters Local Union 602 to update their personal contact information for benefit funds records.
See template
See template
FAA Child Care Subsidy Program Monthly Invoice Form
PDF template
A form for FAA employees to submit monthly child care service costs and receive subsidy reimbursement.
See template
See template
FAA Student Coaching And Feedback Form
PDF template
A documentation form for supervisor-employee conversations regarding performance coaching and feedback at the FAA.
See template
See template
Appendix 1 To FAA NATCA FFCRA MOU
PDF template
A document for employees to request emergency leave related to COVID-19 under the Families First Coronavirus Response Act.
See template
See template
Faculty Expense Reimbursement Form
PDF template
A form for University of the South faculty to document and request reimbursement for professional expenses and mileage.
See template
See template
FACULTY LED PROGRAM PAYMENT REQUEST FORM
PDF template
A form for requesting payment for faculty-led study abroad program expenses, detailing payment method and vendor information.
See template
See template
Faculty Staff Campaign Payroll Deduction
PDF template
A form for Anna Maria College employees to authorize payroll deductions for charitable giving to the institution.
See template
See template
Payroll Deduction Form
PDF template
A document allowing employees to authorize monthly or one-time payroll deductions for university donations and support various campus programs and funds.
See template
See template
Faculty Travel And Business Expense Report Form
PDF template
A form for University of the South faculty to report and request reimbursement for travel-related expenses and business trips.
See template
See template
Fair Hearing Request Form
PDF template
A form for appealing MassHealth decisions and requesting a fair hearing to challenge agency actions or inactions.
See template
See template
Fall 2023 Veterans Education Benefits Enrollment Form
PDF template
A form for veterans to enroll and verify educational benefits and student status at the University at Buffalo for the Fall 2023 term.
See template
See template
Emergency Sick Leave Request
PDF template
A form for employees to request emergency sick leave due to COVID-19 related reasons between April 1 and December 31, 2020.
See template
See template
Family And Medical Leave Request Form
PDF template
A comprehensive form for employees to request unpaid family and medical leave under federal FMLA guidelines, detailing leave entitlements and notice requirements.
See template
See template
ELIGIBILITY AND BILLING FORM
PDF template
Form for qualifying for corporate and family education benefits at DeVry University, detailing eligibility requirements and student/employer information.
See template
See template
NECAIBEW Family Medical Care Plan Family Enrollment Form
PDF template
An enrollment form for employees to enroll in the NECA/IBEW Family Medical Care Plan, including personal, spousal, and dependent information.
See template
See template
Family Medical Leave Request Form
PDF template
A form for Rappahannock County Public Schools employees to request family or medical leave with required documentation from healthcare providers.
See template
See template
APPLICATION FOR GRANT OF FAMILY PENSION
PDF template
Application form for requesting family pension benefits from Bank of Baroda Pension Fund Trust after the death of a pensioner.
See template
See template
Educational Benefit Tax Exemption Frequently Asked Questions
PDF template
A guide explaining tax implications and procedures for educational assistance benefits through UET (University/Employer Training) program.
See template
See template
FAQS For CARE Reimbursement Form
PDF template
Frequently asked questions document providing guidance on reimbursement process for CARE grant recipients about submission, payment, and documentation requirements.
See template
See template
Frequently Asked Questions (FAQs) (Part Time Worker Trainer)
PDF template
Comprehensive guide for part-time worker trainers explaining payment processes, expense reimbursement, and tax form requirements.
See template
See template
Frequently Asked Questions (FAQs) Part Time Worker Trainer
PDF template
Comprehensive guide for part-time worker-trainers covering payment processing, direct deposit, tax forms, and expense reimbursement procedures.
See template
See template
FAQs CVS Caremark Pharmacy Transition
PDF template
Frequently asked questions about prescription drug benefits transition from Medco to CVS Caremark for PERS Select/Choice/Care members.
See template
See template
FAS Payment Request Invoice Form
PDF template
A form for submitting payment requests for refunds, honorariums, prizes, and fellowships within an organization.
See template
See template
Dual Benefits Reimbursement Form
PDF template
A form for open-shop contractors to request reimbursement for employer-sponsored benefit plan contributions while working on City of Seattle projects.
See template
See template
Retiree Enrollment Form
PDF template
Enrollment form for Fulton County retirees to select health and dental plan coverage options and update personal information.
See template
See template
STATEMENT OF FACTS SUPPORTING ELIGIBILITY FOR AFDC FOSTER CARE(FC)
PDF template
California state form documenting a foster child's eligibility for AFDC-Foster Care benefits and personal information.
See template
See template
FCC Form 472
PDF template
A form for schools, libraries, or consortia to request reimbursement for discounts on approved services already paid for by the billed entity.
See template
See template
INCLUSA CLAIM FORM
PDF template
A claim form for submitting healthcare service claims to Inclusa Family Care through WPS Health Insurance.
See template
See template
Faculty Development Committee (FDC) Disbursement Expense Reporting
PDF template
Guidelines for faculty expenses, reimbursement processes, and fiscal year spending for Regis University faculty development funds.
See template
See template
Dependent Day Care Claim Form
PDF template
Form for submitting dependent day care expenses for reimbursement through a flexible spending account.
See template
See template
Claim For Dismemberment Benefits
PDF template
A federal employee insurance claim form for documenting loss of limb or eyesight benefits under the Federal Employees' Group Life Insurance Program.
See template
See template
Fee Agreement
PDF template
A fee agreement document for a special needs or educational trust, outlining trustee compensation and expense reimbursement terms.
See template
See template
Right To Know Program Fee Invoice
PDF template
Invoice for reporting chemical substances under New York City's Right-to-Know Program for environmental compliance
See template
See template
Health Benefits Claim Form
PDF template
A comprehensive form for submitting health insurance benefits claims, including patient and insurance information.
See template
See template
Florida Empowerment Scholarship For Students With Unique Abilities (FES UA) ParentGuardian Expense R
PDF template
A form for parents/guardians to request reimbursement for eligible educational expenses for students with unique abilities under the Florida Empowerment Scholarship program.
See template
See template
FAMILIES FIRST CORONAVIRUS RESPONSE ACT LEAVE REQUEST FORM
PDF template
Form for employees to request leave under the Families First Coronavirus Response Act for COVID-19 related reasons
See template
See template
Leave Request Form Families First Coronavirus Response Act Employee Paid Leave
PDF template
A form for employees to request paid or unpaid leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
See template
See template
Families First Coronavirus Response Act (FFCRA) Leave Request
PDF template
Form for employees to request paid sick leave and expanded family medical leave related to COVID-19 pandemic
See template
See template
COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave due to COVID-19 related reasons under the Emergency Paid Sick Leave Act.
See template
See template
FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA) LEAVE REQUEST FORM
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act for various COVID-19 related reasons.
See template
See template
Care For Older Adults Assessment Form
PDF template
Comprehensive medical assessment form for evaluating functional, cognitive, and sensory status of older adult patients.
See template
See template
CSB And CoC Invoicing Frequently Asked Questions
PDF template
A comprehensive guide explaining invoicing procedures, budget constraints, and documentation requirements for Community Service Board (CSB) and Continuum of Care (CoC) contracts.
See template
See template
UHC WTIA (EnrollCancelWaiverChanges)
PDF template
A comprehensive form for employees to enroll, modify, or cancel health insurance benefits and personal information.
See template
See template
SMACNA Expense Reimbursement Statement
PDF template
A form for SMACNA directors, committee members, and representatives to request reimbursement for official business expenses.
See template
See template
AccidentIncident Report Form
PDF template
A comprehensive form for documenting workplace accidents, incidents, and related details for reporting and prevention purposes.
See template
See template
CLAIM FORM MISCELLANEOUS EXPENSES
PDF template
A form for submitting and documenting miscellaneous expense claims for reimbursement or processing.
See template
See template
Change Of Address Notice
PDF template
Official form for updating member contact information with the New York City District Council of Carpenters Benefit Funds.
See template
See template
Confidentiality Agreement
PDF template
A comprehensive confidentiality agreement outlining information protection requirements for employees and contractors of A & T.
See template
See template
SHIP Payment Of Damages Form
PDF template
A form for documenting damage payments to landlords through a housing support program, allowing tenants to maintain or obtain new housing.
See template
See template
Direct Deposit Form For NYS Employees
PDF template
A form for New York State employees to set up, modify, or cancel direct deposit of their salary into bank accounts.
See template
See template
Redemption Chapel Payroll Direct Deposit Form
PDF template
A form for employees to provide bank account details for direct deposit of payroll earnings.
See template
See template
DOTM FORM 1024 FFCRA SICK LEAVE REQUEST
PDF template
A form for employees to request paid sick leave under the Families First Coronavirus Response Act (FFCRA) during the COVID-19 pandemic.
See template
See template
Expense Report Form
PDF template
A form for employees to document and request reimbursement for travel-related expenses including airfare, hotel, meals, mileage, and other costs.
See template
See template
Loan Application Form
PDF template
A loan application form for University of the Philippines employees with different loan amount limits based on employee classification.
See template
See template
Employee Handbook
PDF template
Comprehensive guide detailing company policies, employee benefits, conduct expectations, and workplace guidelines for employees.
See template
See template
Meal Count And Attendance Form
PDF template
A form used to track meals and attendance for a child care food program provider, including meal counts and reimbursement calculations.
See template
See template
Auto Reimbursement Worksheet
PDF template
A form for tracking and requesting reimbursement for business-related vehicle mileage by staff and board members.
See template
See template
HOME EDUCATION REIMBURSEMENT REQUEST
PDF template
A form for parents to request reimbursement for educational expenses related to a student's home education program.
See template
See template
Sick Leave Request Form
PDF template
A form for employees to request sick leave and associated pay, to be processed by the payroll department.
See template
See template
Domestic Guest Travel Request
PDF template
A comprehensive form for domestic travel arrangements and reimbursement guidelines for guests visiting the University of North Carolina.
See template
See template
CounterPulse Invoice Form
PDF template
A comprehensive invoice form for capturing payment details, expenses, and accounting information for independent contractors and vendors.
See template
See template
Travel Form
PDF template
Document for tracking and requesting reimbursement for employee travel expenses including lodging, transportation, and meals.
See template
See template
TIME OFF REQUEST FORM
PDF template
A form for employees to request time off for various reasons including vacation, sick leave, or personal reasons.
See template
See template
Summer Reimbursement Request Form
PDF template
A form for GGMS students to request reimbursement for summer courses taken at eligible institutions when not degree-seeking at the specific institution.
See template
See template
Business Expense Policy
PDF template
A comprehensive policy defining guidelines for business expenses incurred by Worcester Polytechnic Institute faculty, staff, and students while conducting university business.
See template
See template
Travel Procedure
PDF template
Comprehensive guide for organizational travel expenses, reimbursement procedures, and required documentation for travel-related spending.
See template
See template
Finance Forum Notes
PDF template
Internal meeting notes covering student employment I-9 process, IT training, year-end fiscal activities, and department invoicing procedures.
See template
See template
Mansfield Independent School District Business Procedures Manual, Section 6 EmployeeStudent Travel
PDF template
Detailed guidelines for travel expenses, reimbursement, and approval process for Mansfield Independent School District employees and students.
See template
See template
Financial Policies
PDF template
Comprehensive policy document providing guidance for financial transactions, reimbursements, and expenditure guidelines for university employees.
See template
See template
Financial Policies
PDF template
Comprehensive policy providing guidance on financial transactions, reimbursements, and expenditure approvals for university employees.
See template
See template
FINANCIAL SYSTEMDIRECT DEPOSIT FORM FOR TRAVEL PAYMENTS
PDF template
A government form for processing travel and relocation expense reimbursements with direct deposit information.
See template
See template
Expenses Non Employee And Student Reimbursement Form
PDF template
A guide for non-employees, students, and student organizations to submit expense reimbursement requests for University-related expenses.
See template
See template
Check Requisition Form
PDF template
A form for requesting checks for specific purposes like travel advances, subscriptions, and authorized special purchases with detailed processing instructions.
See template
See template
Marywood University Travel Expense Reimbursement Form
PDF template
A form for employees to document and request reimbursement for travel-related expenses incurred during university business.
See template
See template
Marywood University Travel Expense Reimbursement Form
PDF template
University form for employees to submit and track travel-related expenses for reimbursement or reconciliation.
See template
See template
COVID 19 Paid Sick Leave Act Request Form
PDF template
Form for employees to request paid sick leave due to COVID-19 quarantine or isolation orders in New York State.
See template
See template
Employee Voluntary Payroll Deduction Authorization For Fitness Center Usage Fee
PDF template
Voluntary authorization form for employees to have fitness center usage fee deducted from their paycheck
See template
See template
Payroll Deduction For Fitness Center Membership
PDF template
A form for employees to authorize payroll deductions for fitness center membership at Clayton State University.
See template
See template
Membership Benefits And Rates Guide For Douglas County Employees
PDF template
Comprehensive guide detailing fitness center membership options, rates, and benefits for Douglas County employees.
See template
See template
Management Benefits Fund (MBF) Health And Fitness Reimbursement Program Claim Form
PDF template
A form for MBF members to claim reimbursement for health and fitness expenses for themselves and their spouse/domestic partner.
See template
See template
Payroll Deduction Form For The SSU Employee Fitness Plan
PDF template
Form for faculty and staff to enroll in Savannah State University's fitness plan with payroll deduction options.
See template
See template
Harvard Pilgrim Fitness Reimbursement Form
PDF template
Form and instructions for health club membership reimbursement through Harvard Pilgrim Health Care for eligible members.
See template
See template
2024 Fitness Reimbursement Program
PDF template
A program offering up to $300 per family annually for eligible fitness expenses for University System of New Hampshire employees and dependents.
See template
See template
HealthFitness Center Reimbursement Form
PDF template
A form for Capital Health Plan members to request reimbursement for health and fitness center memberships up to $150 per family or member.
See template
See template
Fitness Benefit Coverage Form Instructions
PDF template
Instructions and form for members to request reimbursement for fitness-related expenses through their health plan
See template
See template
Fitness Reimbursement Form Instructions
PDF template
Instructions for submitting fitness facility membership reimbursement claims through Harvard Pilgrim Health Care.
See template
See template
Flex Card Refund Request Form
PDF template
Form for Peak Advantage members to request reimbursement for out-of-pocket medical co-payments or co-insurances when flex card transactions fail.
See template
See template
M0272B Flexible Spending Account Claim Form
PDF template
A form for participants to request reimbursement for dependent care and unreimbursed medical expenses from their Flexible Spending Account.
See template
See template
PF 132 (10 18) SUNY Reimbursement Accounts Enrollment Form
PDF template
Form for employees to enroll in health care and dependent care flexible spending accounts with pre-tax payroll deductions.
See template
See template
Direct Deposit Authorization
PDF template
A form for employees to authorize direct deposit of payments or reimbursements with bank account details.
See template
See template
Reimbursement Form For Flexible Spending Account (FSA)
PDF template
Form for employees to request reimbursement for healthcare and dependent care expenses through a Flexible Spending Account.
See template
See template
MEDICAL FLEX REIMBURSEMENT FORM
PDF template
A form for employees to request reimbursement for medical and dental expenses through a flexible spending account program.
See template
See template
BESTflex Plan Election Form
PDF template
Document for employees to elect participation in flexible spending accounts for healthcare and dependent care expenses
See template
See template
Flexible Spending Account Direct Deposit Form
PDF template
A form for authorizing electronic transfer of Flexible Spending Account reimbursement checks to a personal bank account.
See template
See template
Flowchart 11 Project Closure
PDF template
Detailed procedural flowchart for closing out a public agency construction project, including documentation, payments, and final approvals.
See template
See template
Federal Student Loan Repayment Program Calendar Year 2017
PDF template
Annual report detailing federal agencies' use of student loan repayment benefits for employee recruitment and retention during 2017.
See template
See template
FM EXP TravelAuthorizationForm 001
PDF template
A form for obtaining prior authorization for out-of-state or out-of-country employee travel with specific conditions and usage guidelines.
See template
See template
FAMILY MEDICAL LEAVE EMPLOYEE LEAVE REQUEST FORM
PDF template
A form for employees to request medical or family leave under FMLA and NJFLA regulations, documenting eligibility and reasons for leave.
See template
See template
City Of Round Rock Request For FMLA Leave
PDF template
Official document for City of Round Rock employees to request Family and Medical Leave Act (FMLA) leave for various personal and family health situations.
See template
See template
Leave Request Form Federal COVID 19 FFCRA
PDF template
A form for employees to request paid leave under the Families First Coronavirus Response Act (FFCRA) for COVID-19 related reasons.
See template
See template
FAMILY MEDICAL LEAVE (FMLA) REQUEST FORM
PDF template
A form for employees to request Family and Medical Leave Act (FMLA) leave for various qualifying reasons including personal or family medical conditions, birth, adoption, or military-related leave.
See template
See template
FAMILY OR MEDICAL LEAVE REQUEST FORM
PDF template
A form for employees to request family or medical leave for various personal and family health-related reasons.
See template
See template
FMLA LEAVE REQUEST FORM
PDF template
A form for employees to request leave under the Family and Medical Leave Act for various personal and family health-related reasons.
See template
See template
Family And Medical Leave (FML)Paid Parental Leave (PPL) Request Form
PDF template
A comprehensive form for employees to request family and medical leave, including parental leave, for various qualifying reasons.
See template
See template
Family And Medical Leave (FML)Paid Parental Leave (PPL) Request Form
PDF template
A form for employees to request family and medical leave or paid parental leave, including various qualifying reasons for absence.
See template
See template
Family Medical Leave Request Form (FMLA)
PDF template
Form for employees to request Family and Medical Leave for various personal and family health-related reasons.
See template
See template
Reimbursement Form Non Employee Travel Reimbursement
PDF template
A form for submitting travel expenses for reimbursement by non-employees of an organization.
See template
See template
Confirmation Of Attendance Form
PDF template
A form used by First Nations Health Authority to confirm patient attendance for medical transportation reimbursement and travel arrangements in British Columbia.
See template
See template
FNIS Request Form
PDF template
Form for nonresident employees and students to provide immigration and personal information for tax withholding purposes at Northwestern University.
See template
See template
FNS 415 Interviewing
PDF template
Guidelines for conducting interviews for Food and Nutrition Services benefit applications, outlining interview requirements and interviewer responsibilities.
See template
See template
Food And Nutrition Services Certification Applications FNS 415 Interviewing
PDF template
Guidelines for conducting interviews for Food and Nutrition Services benefits application process, detailing interview requirements and interviewer responsibilities.
See template
See template
U.S. BANK FOCUS CARD Enrollment Form
PDF template
Enrollment form for obtaining a U.S. Bank Focus Card with personal and employment information collection
See template
See template
Food Delivery Checklist
PDF template
Comprehensive checklist for state agencies managing WIC food delivery systems, vendor management, and food benefit distribution.
See template
See template
Food Purchase
PDF template
A form for documenting food purchases, including details of purchase, amount, and approvals.
See template
See template
Food Purchase Form
PDF template
A form for documenting food purchases for meetings, events, or bulk food acquisitions by government agencies.
See template
See template
FOOTWEAR SELECTION AND PROCUREMENT PROCEDURE
PDF template
Procedure for selecting and procuring protective footwear for employees with safety requirements and reimbursement guidelines.
See template
See template
Foreign Change Of Address Form
PDF template
Form for updating international employee address and tax document delivery preferences at the University of Pittsburgh.
See template
See template
Foreign Travelers Check List
PDF template
Comprehensive guide outlining documentation requirements for foreign travelers seeking honoraria, travel expense reimbursement, or entering the U.S. while applying for permanent residency.
See template
See template
Termination Refund Application
PDF template
A form for APERS members to request a termination refund with options for direct deposit or rollover of retirement benefits.
See template
See template
PBGC Form 10 Post Event Notice Of Reportable Events
PDF template
A form for reporting significant events related to pension plans that may impact plan participants and financial stability.
See template
See template
Form 11 LEAVE REQUEST FORM
PDF template
A form for employees to request various types of leave, including vacation, sick, and compensation time, with supervisor approval.
See template
See template
Change Of Address Form RetireesBenefit Recipients
PDF template
Official form for updating personal contact information for retirees and benefit recipients of Arkansas Retirement System.
See template
See template
Claim For Reimbursement Corrective Action (Form 3)
PDF template
Instructions for submitting a claim for reimbursement of corrective action costs associated with petroleum tank release cleanup in Montana.
See template
See template
Individual Unemployability (IU Or TDIU) Intake Form
PDF template
A comprehensive intake form for veterans seeking total disability benefits based on individual unemployability due to service-related medical conditions.
See template
See template
FORM 68 EMPLOYEE DISCIPLINARY ACTION FORM
PDF template
A formal document used to record and document employee workplace violations and disciplinary actions.
See template
See template
Dependency And Indemnity Compensation (DIC) Intake Form
PDF template
A form for surviving spouses, children, or dependent parents to apply for monthly compensation based on a veteran's service-connected death or disability.
See template
See template
Energy Assistance Program Change Of Address Form
PDF template
Form for updating contact and utility information when moving to a new address while receiving energy assistance benefits.
See template
See template
Adoption Assistance Reimbursement Request Form
PDF template
A form for employees to request reimbursement for eligible adoption expenses up to $10,000.
See template
See template
FORM A TRAVEL APPROVALEXPENSE REPORT
PDF template
A comprehensive form for documenting and obtaining approval for travel expenses for college business and requesting travel advances.
See template
See template
SEIU Michigan Health And Welfare Fund MemberS Change Of Address Form
PDF template
A form for SEIU Michigan Health and Welfare Fund members to update their personal and employment information.
See template
See template
Form DFS F5 DWC 10
PDF template
A billing form for pharmacists and medical suppliers to file reimbursement for workers' compensation medical services and supplies.
See template
See template
Commonwealth Of Massachusetts EMPLOYEE REIMBURSEMENT FORM
PDF template
A form for Massachusetts state employees to submit expenses and mileage for reimbursement, including private auto mileage, meals, fares, and other expenses.
See template
See template
BMW CCA Expense Report Form
PDF template
A comprehensive form for BMW Car Club of America members to report and request reimbursement for travel and administrative expenses.
See template
See template
Monticello Women Of Today Check Requisition Form
PDF template
A form used by the Monticello Women of Today organization to request and track financial reimbursements for expenses.
See template
See template
FMLA LEAVE REQUEST FORM
PDF template
A form for employees to request family or medical leave, documenting leave details and employee information.
See template
See template
COVID 19 LEAVE REQUEST FORM
PDF template
A form for employees to request leave related to COVID-19 situations and circumstances
See template
See template
Permanent Mailing Address Form
PDF template
A comprehensive form for collecting personal and professional information for employment and retirement system membership in Ohio
See template
See template
Accident Investigation Form (Example 2)
PDF template
A comprehensive form for documenting and investigating workplace accidents, collecting details about the incident, affected employee, and supervisor's assessment.
See template
See template
Employer Sponsored Program How To File A Claim For Approval
PDF template
Comprehensive guide for employees on submitting claims through a healthcare benefits platform with detailed filing instructions and documentation tips.
See template
See template
Form M 1 Report For Multiple Employer Welfare Arrangements (MEWAs) And Certain Entities Claiming Exc
PDF template
A U.S. Department of Labor form for reporting multiple employer welfare arrangements and entities claiming exception under ERISA regulations.
See template
See template
Member Interview Form
PDF template
A comprehensive form for gathering detailed personal information and preferences about a care member's activities, interests, and support needs.
See template
See template
Planning And Evaluation Form
PDF template
A comprehensive form for documenting employee performance goals, objectives, and achievements for an annual performance review cycle.
See template
See template
IBEW LOCAL NO. 461 VARIABLE PENSION PLAN REQUEST FOR APPLICATION FORM
PDF template
A form for IBEW Local No. 461 members to request pension benefits, including normal retirement, early retirement, or total and permanent disability benefits.
See template
See template
IBEW LOCAL NO. 32 NECA PENSION PLAN REQUEST FOR APPLICATION FORM
PDF template
A form for requesting pension benefits from the IBEW Local No. 32 NECA Pension Plan, allowing participants to apply for various retirement options.
See template
See template
Plumbers And Pipefitters Local 333 Pension Fund Request For Application Form
PDF template
A form for requesting a pension application for members of Plumbers and Pipefitters Local #333 Pension Fund seeking retirement benefits.
See template
See template
Form R Retiree Request Form
PDF template
A form for FedEx retirees to request travel tickets for themselves and eligible dependents using travel benefits.
See template
See template
Prescription Drug Reimbursement Coordination Of Benefits Claim Form
PDF template
A form for submitting prescription drug reimbursement claims with details about medication, pharmacy, and patient information.
See template
See template
In Processing Forms Checklist
PDF template
Comprehensive checklist for new federal employees joining the Federal Retirement Thrift Investment Board (FRTIB) to complete required employment and benefits documentation.
See template
See template
Messiah University Form Collection
PDF template
A comprehensive list of administrative forms used across various departments at Messiah University for different financial and administrative purposes.
See template
See template
Shared Leave Program Procedure And Request Form
PDF template
A comprehensive procedure for Pierce College District employees to donate and receive leave time under specific qualifying circumstances.
See template
See template
Change Address
PDF template
Guide for employees to update personal information and manage insurance-related documentation
See template
See template
PRESCRIPTION ORDER FORM
PDF template
A form for obtaining physician authorization for reimbursement of healthcare products and services requiring medical prescription.
See template
See template
Workplace Complaint Form
PDF template
A form for filing workplace complaints by employees at a university medical center, detailing procedures for submitting grievances through Employee and Labor Relations.
See template
See template
Gift Authorization Form Employee Payroll Deduction
PDF template
A form allowing employees of Yuba Community College District to authorize recurring payroll deductions for foundation gifts and scholarships.
See template
See template
Employee Donation Payroll Deduction Form
PDF template
A form for employees to make charitable donations to support various initiatives at the OCCC Foundation through payroll deductions or one-time gifts.
See template
See template
Employee Payroll Deduction Pledge Form
PDF template
A form allowing employees to authorize recurring payroll deductions for charitable donations to the college foundation.
See template
See template
Payroll Deduction AuthorizationChange Form
PDF template
A form for Pierce College employees to authorize payroll deductions for charitable donations to the Legacy of Excellence Fund.
See template
See template
Employee Performance Review
PDF template
A comprehensive form for assessing employee performance across multiple professional competencies and skills.
See template
See template
Employee Performance Review
PDF template
A comprehensive document for assessing employee job performance across multiple professional competencies and behaviors
See template
See template
Time Off Request Form
PDF template
A form for employees to request and record time off from work, requiring supervisor and manager approval.
See template
See template
Frequently Asked Questions For Tuition Benefit
PDF template
Comprehensive guide explaining application process, deadlines, and details for tuition benefit programs at Augsburg University and partner institutions.
See template
See template
Time Off Request Form Hourly
PDF template
A form for hourly employees to request and track paid time off hours based on service tenure and average worked hours.
See template
See template
Enrollment Form
PDF template
Comprehensive enrollment form for fringe benefits including health care, life insurance, and retirement plans for carpenters in Western Washington.
See template
See template
Medical Reimbursement Form
PDF template
A comprehensive checklist for submitting medical reimbursement claims to Mass General Brigham Health Plan, detailing required documentation and submission process.
See template
See template
FAMILY FIRST CORONAVIRUS RESPONSE ACT (FFCRA) OREGON FAMILY LEAVE ACT (OFLA) LEAVE REQUEST FORM
PDF template
A form for employees to request leave under FFCRA and OFLA due to COVID-19 related circumstances
See template
See template
Public Safety Officers Benefits (PSOB) Program History
PDF template
Document detailing the history and purpose of the Public Safety Officers' Benefits Act, which supports law enforcement and firefighter recruitment and retention.
See template
See template
Section 125 Flexible Benefit Plan Direct Deposit Form
PDF template
A form for employees to authorize direct deposit of flexible benefit plan funds to a designated bank account.
See template
See template
Direct Deposit Authorization Request
PDF template
Form for authorizing direct deposit of funds into a checking or savings account for FSA (Flexible Spending Account) reimbursements.
See template
See template
Claim Form
PDF template
A form for submitting out-of-pocket healthcare and dependent care expense reimbursement claims through a flexible spending account.
See template
See template
FSA CLAIM FORM
PDF template
A form for employees to request reimbursement for healthcare and dependent care expenses through a flexible spending account.
See template
See template
Flexible Spending Account Reimbursement Request Form
PDF template
A form for employees to request reimbursement for healthcare and dependent care expenses through a Flexible Spending Account.
See template
See template
How To Submit Claims
PDF template
Detailed instructions for submitting healthcare expense claims with required documentation and submission methods.
See template
See template
Flexible Spending Account Claim Form
PDF template
A form for employees to request reimbursement for healthcare and dependent care expenses through a Flexible Spending Account.
See template
See template
Reimbursement Form
PDF template
A form for employees to submit healthcare and dependent care expenses for reimbursement through Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA)
See template
See template
FSA Dependent Care Reimbursement Form
PDF template
A form for submitting dependent care expenses for reimbursement through a flexible spending account.
See template
See template
Authorization Agreement For Direct Deposit Of Flex Or Transit Reimbursement
PDF template
Form for employees to set up, change, or cancel direct deposit for expense reimbursement with Employee Benefit Specialists (EBS)
See template
See template
Flexible Spending Accounts (FSA) Program EnrollmentChange Form
PDF template
Form for enrolling in or changing Health Care Flexible Spending Account (HCFSA) or Dependent Care Assistance Program (DeCAP) for Plan Year 2023
See template
See template
2024 Flexible Spending Account EnrollmentChange Form
PDF template
A form for employees to enroll in or modify their Flexible Spending Account benefits for healthcare and dependent care expenses
See template
See template
Enrollment Form Flexible Spending Account(S)
PDF template
A form for employees to enroll in healthcare and dependent care flexible spending accounts, specifying contribution amounts and acknowledging plan rules.
See template
See template
Healthcare FSA Expense Claims
PDF template
A form for submitting unreimbursed medical expenses for reimbursement through a Flexible Spending Account (FSA)
See template
See template
Health And Dependent Day Care Reimbursement Form
PDF template
Form for submitting health care and dependent day care expense claims under a Section 125 Cafeteria Plan for reimbursement.
See template
See template
Reimbursement Of Orthodontic Expenses
PDF template
Detailed guidelines for reimbursing orthodontic expenses, explaining IRS guidelines and requirements for monthly service reimbursements.
See template
See template
Recurring Claim Form
PDF template
A form for employees to automate reimbursement of qualified expenses with fixed payments to a service provider.
See template
See template
Reimbursement Form
PDF template
Form for submitting healthcare expense reimbursement claims through Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA)
See template
See template
Flexible Spending Account Reimbursement Request Form
PDF template
A form for employees to request reimbursement for eligible healthcare and dependent care expenses through a flexible spending account.
See template
See template
Request For Reimbursement Form
PDF template
A form for employees to request reimbursement for health care and dependent day care expenses through an employer's flexible spending account.
See template
See template
Discrimination Complaint Form
PDF template
Form for reporting discrimination complaints by students, employees, or other individuals within the college community.
See template
See template
ICS 213 General Message
PDF template
A form for documenting and approving expense reimbursement for resources mobilized under CFAA (California Fire Assistance Agreement)
See template
See template
REQUEST FOR REIMBURSEMENT FORM
PDF template
Form for requesting reimbursement of expenses by USDA Forest Service employees and volunteers
See template
See template
Food ServicesBusiness Meal Approval Form
PDF template
A form used to request and document approval for business meal expenses within an organization.
See template
See template
FS Form 7600B
PDF template
Government form for establishing agreements between federal program agencies for reimbursable buy/sell activities and order tracking.
See template
See template
Virginia Tech Employee Software Sales Order Form
PDF template
A form for Virginia Tech employees to purchase software licenses and technology accessories at discounted rates.
See template
See template
RMBL ReimbursementReceipt Form
PDF template
A form for employees to submit expenses and request reimbursement from their organization, requiring personal and supervisor details.
See template
See template
PENSION BENEFIT APPLICATION FORM
PDF template
A comprehensive pension benefit application form for members to provide personal, marital, and employment information to determine benefit entitlement.
See template
See template
Fund Eligibility And Membership Section
PDF template
Document outlining eligibility requirements, enrollment procedures, and membership terms for a health insurance fund covering active and retired employees.
See template
See template
Funeral Benefit Application Form
PDF template
Application form for claiming funeral benefits through the JLT (CSI Member Benefits) Discretionary Trust
See template
See template
Donor Care Reimbursement
PDF template
A detailed guide outlining reimbursement fees and requirements for funeral homes participating in organ and tissue donation processes.
See template
See template
Funeral Home Reimbursement Form
PDF template
Form for reimbursing funeral homes for additional costs associated with preparing and reconstructing organ, tissue, or eye donors for family viewing.
See template
See template
ORGANIZATION OF STAFF ANALYSTS FURLOUGH SURVEY FORM
PDF template
Survey form for staff members to indicate interest in taking a voluntary leave of absence with potential health benefit considerations.
See template
See template
FURLOUGH SURVEY FORM
PDF template
Survey form for staff analysts to indicate interest in taking a leave of absence with health benefit conditions.
See template
See template
Out Of Network Claim Form
PDF template
A comprehensive form for submitting out-of-network vision care claims to EyeMed Vision Care for reimbursement of medical services.
See template
See template
FY13 Annual Report Form
PDF template
Annual report documenting University Information Services (UIS) activities, accomplishments, and strategic alignment for fiscal year 2013.
See template
See template
Organizational Membership Form
PDF template
Form for organizations to become members of MAPS with different membership levels and benefits
See template
See template
HDOA Seafood Processors Pandemic Response Form A
PDF template
Application form for seafood processors seeking reimbursement for COVID-19 related costs under USDA block grant program.
See template
See template
Benefits Open Enrollment Form 2020
PDF template
Form for employees to select or modify healthcare coverage options and provide personal information for benefits enrollment.
See template
See template
FY2025 Missouri Arts Council Invoice For Reimbursement
PDF template
Invoice form for arts organizations to request reimbursement for funded projects from the Missouri Arts Council for fiscal year 2025.
See template
See template
University Travel Regulations (PM 13)
PDF template
A comprehensive guide outlining travel policies and procedures for university employees, including airfare purchasing and reimbursement rules.
See template
See template
FYS 75 Community Building Accounts Payable Guidelines
PDF template
Guidelines for First Year Seminar instructors on spending $75 for community building activities, including reimbursement procedures and food ordering requirements.
See template
See template
Form G 615 (06 19) EmployerS Supply Requisition
PDF template
A form used by employers to request informational materials from the U.S. Railroad Retirement Board about retirement, survivor, unemployment, and sickness benefits.
See template
See template
DR 1 Disability Benefit Application
PDF template
A comprehensive form for Ohio Public Employees Retirement System members to apply for disability benefits, requiring detailed personal and physician information.
See template
See template
Summary Plan Description
PDF template
A summary document detailing the retirement savings plan for Gannon University employees, explaining plan features, benefits, and participant obligations.
See template
See template
Time Off Request Form
PDF template
A form for employees to request personal or sick time off, with details about coverage and documentation.
See template
See template
Hopelink Gas Card Reimbursement Form
PDF template
Form for requesting reimbursement for medical transportation gas expenses through Hopelink transportation services.
See template
See template
PATIENT MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form for patients at Gateway ENT to collect personal health information, medical history, and family health background.
See template
See template
Professional Leave And Travel Approval Form
PDF template
A form for requesting and documenting professional leave, travel, and associated expenses for school staff.
See template
See template
GEARS Checklist For Judicial Branch Expense Account Form
PDF template
Comprehensive checklist for accurately entering and submitting expense vouchers in the GEARS system for the Judicial Branch.
See template
See template
Medical Claim Form
PDF template
Comprehensive guide for completing and submitting medical insurance claims to GEHA, including instructions for in-network and out-of-network claims.
See template
See template
General Expense Approval Form
PDF template
A form for submitting and approving expenses incurred on official University business by Berkeley Law employees.
See template
See template
General Expense Approval Form
PDF template
A form for employees to request reimbursement for official university business expenses with required signatures and documentation.
See template
See template
General Inquiry Form
PDF template
A form for individuals to submit questions or issues related to Medicaid services and benefits.
See template
See template
Request For Leave Of Absence Form
PDF template
A comprehensive form for employees to request leave of absence for various personal and family reasons, including documentation requirements.
See template
See template
Bridge To Wellness Wellbeing Program General Medical Form
PDF template
A form for employees to document preventative medical, dental, eye, and dermatology examinations for a workplace wellness program.
See template
See template
Texas Tech Student Government Association General Reimbursement Form
PDF template
Form for student organizations to request financial reimbursement for various expenses from Texas Tech Student Government Association.
See template
See template
Texas Tech Student Government Association General Reimbursement Form
PDF template
A form for Texas Tech student organizations to request financial reimbursement for various expenses such as postage, supplies, and advertising.
See template
See template
GENERAL CLAIM SUBMISSION FORM
PDF template
A comprehensive form for submitting insurance claims with sections for member information, coverage details, and claim specifics.
See template
See template
Invoice
PDF template
A form for submitting payment requests or reimbursements at California State University, Sacramento
See template
See template
Invoice
PDF template
A form for submitting service reimbursement requests to the CSU San Bernardino Accounting Office.
See template
See template
Personal Vehicle Use Form
PDF template
Form documenting employee personal vehicle usage and insurance details for official district business and field trips.
See template
See template
Make Sure You Receive Your Retirement Benefits On Time
PDF template
A guide for managing the transition to pension payments, focusing on documentation and timing for retirement benefits from the Government Employees Pension Fund.
See template
See template
Employer Notice Of Claim Long Term Disability
PDF template
A comprehensive claim package for employers to submit long-term disability claims for employees, including detailed instructions and employee information sections.
See template
See template
Short Term Disability Claim Form
PDF template
A form for employees to file a claim for short-term disability benefits, documenting medical leave and disability details.
See template
See template
Quartz Medicare Advantage (HMO) Quartz CashCard Reimbursement Form
PDF template
Form for Medicare members to request reimbursement for fitness memberships or medical transportation rides using their Quartz CashCard.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for submitting dental insurance claims, capturing patient, subscriber, and dental service details.
See template
See template
Payroll Deduction Form For Charitable Contributions To The University Of California, Santa Barbara
PDF template
A form allowing employees to set up monthly charitable contributions to the UCSB Foundation's Sustainable Transportation Fund through payroll deduction.
See template
See template
Request For Benefits ClaimantS Report Of Loss
PDF template
A claim form for filing disability benefits for Glaziers, Architectural Metal and Glass Workers Local Union 1399 members.
See template
See template
Short Term Disability Claim Form Statement Of Employee
PDF template
A comprehensive form for employees to file a short-term disability claim with detailed personal, employment, and medical information.
See template
See template
Golden Ticket Arts Guide Reimbursement Form
PDF template
Reimbursement form for arts organizations participating in Miami-Dade County's Golden Ticket program for event ticket redemptions.
See template
See template
Travel Policy And Procedures For Members Staff Travelling On Behalf Of The Association
PDF template
Comprehensive policy outlining travel expense reimbursement guidelines and requirements for GRAR members and staff.
See template
See template
Funeral Home Billing Form
PDF template
Form for funeral homes to request reimbursement for additional services related to organ donor preparation and recovery.
See template
See template
GPTC Employee Complaint Resolution
PDF template
A procedure establishing a uniform process for resolving employment concerns and encouraging fair communication between employees and supervisors.
See template
See template
Student Health Insurance Plan Cancellation Form
PDF template
Form for cancelling health insurance coverage for spouse, partner, or dependent students at Washington State University for Spring 2024 semester.
See template
See template
Graduate Travel Award Reimbursement Form
PDF template
Form for graduate students to request reimbursement for travel expenses related to conference presentations.
See template
See template
Reimbursement Request
PDF template
Form for requesting reimbursement for emergency or unplanned overtime taxi rides under a Guaranteed Ride Home program.
See template
See template
GRIEVANT INTERVIEW FORM
PDF template
A detailed form for documenting and assessing employee grievances and potential contractual disputes.
See template
See template
Employee GrievanceComplaint Form
PDF template
A formal document for employees to file workplace grievances or complaints through a structured escalation process.
See template
See template
Group Optional Life Insurance Application
PDF template
Insurance application for employees to select optional term life and accidental death & dismemberment (AD&D) coverage for themselves and spouse.
See template
See template
Group Short Term Disability Claim Form
PDF template
A comprehensive form for filing a short-term disability insurance claim with Dearborn National, capturing employee medical and income details.
See template
See template
STUDENT GOVERNMENT FINANCE TRAVEL AUTHORIZATION REIMBURSEMENT FORM
PDF template
A form for University of Florida students to request reimbursement for authorized group travel expenses.
See template
See template
Group Return From Travel Form
PDF template
A comprehensive form for tracking group travel expenses, destinations, and student trip details for organizational reimbursement and record-keeping.
See template
See template
GROUP RETURN FROM TRAVEL FORM
PDF template
A form for documenting student organization travel expenses, trip details, and reimbursement information.
See template
See template
SunAdvantage RRSPDPSPTFSA Sponsor Administration Guide
PDF template
A comprehensive guide for small business owners to manage employee group retirement and savings plans with minimal administrative effort.
See template
See template
Payroll Delivery Form
PDF template
Form for employees to select their preferred method of receiving payroll payments, including direct deposit, pay card, or Western Union transfer.
See template
See template
GSA Application For Funding From The Dedman Graduate Student Assembly
PDF template
Application form and guidelines for graduate students seeking reimbursement for academic expenses and conference-related costs.
See template
See template
GSA Application For Funding
PDF template
Detailed instructions and requirements for graduate students seeking reimbursement from the Graduate Student Assembly for conference or research expenses.
See template
See template
GSO Academic Enrichment Award Checklist
PDF template
Comprehensive checklist for documenting academic travel expenses and reimbursement requirements for GSO funding.
See template
See template
Shared Sick Leave Request Form
PDF template
A form that allows Georgia Tech employees to request donated sick leave when they have exhausted their own paid leave due to serious health conditions.
See template
See template
Your Guide To Filing A Long Term Disability (LTD) Claim
PDF template
A comprehensive guide for filing a long term disability claim with Guardian, providing step-by-step instructions for completing the required forms and submission process.
See template
See template
Guardian Life Insurance Enrollment Form
PDF template
Insurance enrollment form for University of Massachusetts Medical School employees to select benefits and coverage options.
See template
See template
REQUEST FOR PROPOSALS Oracle Customer Cloud Service (CCS, OUAV, OUTA), Oracle Cloud Infrastructure (
PDF template
Request for competitive proposals for Oracle cloud system managed services and support for Greenville Utilities Commission.
See template
See template
Guest Travel Express Profile Reimbursement Form
PDF template
A form for guests to provide personal information and document travel expenses for reimbursement purposes at UCLA.
See template
See template
Guest Travel Form FSU Foundation
PDF template
Form for documenting travel and entertainment expenses for family members or guests to determine tax implications for employees.
See template
See template
VisitorGuest Speaker Form
PDF template
Form for processing payments and reimbursements for international visitors and guest speakers at UCLA with specific visa requirements.
See template
See template
Financial Reimbursement Assistance Guidelines
PDF template
Guidelines for Disadvantaged Business Enterprises to receive financial assistance for transportation-related activities through the BOWD Center.
See template
See template
Abbot Academy Fund Fall 2021 Acceptance Of Guidelines For Grantees
PDF template
Guidelines and instructions for recipients of Abbot Academy Fund grants, detailing fund usage, reporting, and payment procedures.
See template
See template
SOU Guidelines For Hosting Candidates
PDF template
Comprehensive guidelines for university departments hosting job candidates, covering meal expenses, lodging, and reimbursement procedures.
See template
See template
GUILD TIMES ADJUSTABLE PENSION PLAN
PDF template
Summary plan description for a pension plan covering employees of The Times and Guild - Local 31003/TNG union members.
See template
See template
Reimbursement Form
PDF template
A form for submitting optical service reimbursement claims to General Vision Services by members.
See template
See template
REIMBURSEMENT FORM
PDF template
Form for submitting optical services reimbursement to General Vision Services by members.
See template
See template
Travel Expense Form
PDF template
A form for submitting and tracking travel expenses for school-related travel with itemized cost categories.
See template
See template
Gym Reimbursement Form
PDF template
A form to help employees get reimbursed for fitness facility memberships and track workout sessions.
See template
See template
Reasonable Rate Schedule And Reimbursement Guidance Manual
PDF template
Guidance document for reimbursement procedures related to petroleum release remediation and cash fund management.
See template
See template
Reimbursement Request Form
PDF template
A form for members to request reimbursement for eligible healthcare services paid out-of-pocket.
See template
See template
H 4 Dependent Information Sheet
PDF template
Comprehensive form for H-4 visa dependents to provide biographical information and file immigration status documents with USCIS.
See template
See template
Interview Form
PDF template
A document used to collect details about alleged harassment incidents within a school district.
See template
See template
MC Hardware Request
PDF template
A form for requesting computer hardware for Montgomery College employees, with options for remote work and instructional needs.
See template
See template
Settlement Agreement Harper Et Al. V. Massachusetts Department Of Transitional Assistance
PDF template
A settlement agreement addressing access to benefits for individuals with disabilities at the Massachusetts Department of Transitional Assistance
See template
See template
Supplemental Life Insurance
PDF template
Document outlining eligibility, enrollment, and approval process for supplemental life insurance for county employees.
See template
See template
Wellness Reimbursement Form Instructions
PDF template
Instructions and guidelines for submitting wellness program and fitness reimbursement claims through Harvard Pilgrim Health Care.
See template
See template
HAZARD REPORT FORM
PDF template
A standardized form for documenting workplace safety hazards, observations, and recommended corrective actions.
See template
See template
HAZARD REPORT FORM
PDF template
A document for employees to report workplace safety hazards and for management to investigate and resolve potential risks.
See template
See template
Hazard Report Form
PDF template
A comprehensive form for identifying, assessing, and reporting workplace safety hazards with risk assessment matrix.
See template
See template
HC 0030 Retroactive Unlimited Sick Leave Request Form
PDF template
A form for eligible 9/11 rescue and recovery workers to request retroactive unlimited paid sick leave for 9/11-related illnesses.
See template
See template
Hiram College Enrollment Form
PDF template
A comprehensive benefits enrollment form for Hiram College employees covering medical, dental, vision, and supplemental insurance options.
See template
See template
HEALTHCARE ADVOCATE TOOLS LINKS PHONE NUMBERS
PDF template
Comprehensive guide for AlaskaCare employees and retirees with contact information and resources for health insurance plans and provider networks.
See template
See template
1500 Health Insurance Claim Form
PDF template
Standard medical claim form used for submitting healthcare insurance reimbursement requests.
See template
See template
Family Household Income Statement
PDF template
Form for verifying household income and financial assistance for Child Care services through the Ohio Department of Job & Family Services.
See template
See template
Procurement Card Policy
PDF template
Detailed policy outlining procedures for obtaining and using procurement cards for college employees and departments.
See template
See template
3790 SNY Flexible Spending Account Reimbursement Form
PDF template
Detailed instructions for submitting healthcare expense reimbursement claims through a flexible spending account with specific documentation requirements.
See template
See template
Tips For Claim Submission
PDF template
Comprehensive guide for submitting healthcare and flexible spending account claims, detailing documentation requirements and eligible expenses.
See template
See template
Tips For Claim Submission
PDF template
Comprehensive guide for submitting medical expense claims, including eligible expenses, documentation requirements, and over-the-counter medication rules.
See template
See template
Eligibility And Enrollment Information For Employees
PDF template
A comprehensive form for employees to provide personal information and make flexible spending account elections.
See template
See template
Expense Reimbursement Voucher For Healthcare Flexible Spending Account (Healthcare FSA)Health Reimbu
PDF template
A form for employees to request reimbursement for medical expenses through their flexible spending account or health reimbursement arrangement.
See template
See template
Co PayDeductible Reimbursement Form
PDF template
Form for students to request reimbursement for medical co-pays and deductibles, with specific instructions and limitations.
See template
See template
Health Extras Reimbursement Form
PDF template
Form for submitting healthcare service reimbursement claims through Independent Health's Health Extras program.
See template
See template
Student Health Fee Reimbursement Form
PDF template
Form for Florida A&M University law students to request reimbursement for health service fees
See template
See template
HealthFlex Mandatory Premium And Coverage Waiver Form
PDF template
A form for employees to decline health insurance coverage and declare reasons for waiving enrollment in the HealthFlex plan.
See template
See template
Retiree Health Cancellation Form
PDF template
A form for retirees to cancel their health coverage and dependent coverage through Blue Cross Blue Shield.
See template
See template
Health Insurance Waiver Form
PDF template
A form for Genesee Community College employees to waive their group health insurance plan and provide alternative coverage evidence.
See template
See template
Medical Claim Form
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient, subscriber, and medical service details.
See template
See template
Portland Community College HSA Payroll Contribution Form
PDF template
Form for employees to set up pre-tax payroll contributions to a Health Savings Account (HSA) through Optum.
See template
See template
Health Screening Benefit Claim Form
PDF template
Claim form for requesting reimbursement of health screening benefits under critical illness or supplemental health plans.
See template
See template
Waiver Of Group Health Benefits Form
PDF template
Form for California employees to waive group health, dental, and vision coverage while documenting alternative health insurance enrollment.
See template
See template
Faculty Staff Payroll Deduction Form
PDF template
A form for faculty and staff to authorize recurring payroll deductions to support the Herd Rises Campaign scholarship fund.
See template
See template
HealthFlex Mandatory Premium And Coverage Waiver Form
PDF template
A form for employees to decline health coverage with specific documentation of reasons and eligibility conditions.
See template
See template
Disability Claim Form
PDF template
A comprehensive claim form for submitting disability insurance claims with Unum Group subsidiaries.
See template
See template
Statement Of Kurt DelBene On VA.Gov
PDF template
Congressional testimony about the Department of Veterans Affairs' VA.gov website, its usage, services, and digital modernization efforts.
See template
See template
CLM 139 Member Submitted Health Insurance Claim Form
PDF template
A standardized form for submitting health insurance claims with detailed filing instructions for patients and healthcare providers.
See template
See template
Time Off Request Form
PDF template
A form for employees to request various types of time off including vacation, sick pay, bereavement, and medical/dental leave
See template
See template
Hiring Official Checklist
PDF template
Comprehensive guide for hiring managers outlining steps to successfully onboard a new employee from interview through first 90 days.
See template
See template
3.3 Vacation Policy
PDF template
Comprehensive policy outlining vacation time accrual, entitlement, and usage for employees across different service lengths.
See template
See template
HMSA Employee Health Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in HMSA health insurance plans and provide personal and dependent information.
See template
See template
Business Request For Reimbursement
PDF template
A form for businesses to request reimbursement of unclaimed property reported to the Iowa State Treasurer's Office.
See template
See template
Holiday Attendance Form
PDF template
A form for child care providers to document and receive reimbursement for meals served on specific holidays, with parent verification of child attendance.
See template
See template
Holiday Time Off Request Form
PDF template
Internal communication about holiday time off requests and current MVP recognition counts for employees.
See template
See template
Student Organization Request For Reimbursement
PDF template
A form for student organizations to request reimbursement for parade-related decorating supplies up to $200.
See template
See template
Homelessness Prevention Benefit Application For Assistance
PDF template
A benefit program to assist low-income households in Leeds and Grenville with housing stability and prevention of homelessness.
See template
See template
Homelessness Prevention Benefit Application For Assistance
PDF template
A benefit program assisting low-income households in Leeds and Grenville to obtain and retain housing, supporting those at risk of homelessness.
See template
See template
Honoraria Travel Reimbursement Criteria By Visa Types
PDF template
Detailed guidelines for honoraria and travel reimbursement requirements for different visa types, focusing on tax compliance and documentation.
See template
See template
Hospice RevocationDischarge Form
PDF template
A form for documenting hospice patient discharge or service revocation under Medicaid guidelines
See template
See template
CSU, San Bernardino HOSPITALITY EXPENSE APPROVAL FORM
PDF template
A form for approving and documenting hospitality expenses at California State University, San Bernardino.
See template
See template
Foundation Hospitality Expense Approval Form
PDF template
An internal form for documenting and approving hospitality expenses for university events and meetings.
See template
See template
College Of Southern Nevada Hosting Policy
PDF template
Guidelines for purchasing food, beverages, flowers, and small gifts for business-related events and functions at the College of Southern Nevada.
See template
See template
Hotel Direct Bill Authorization Form
PDF template
Form for authorizing direct hotel billing for business-related travel and stays at Hobart and William Smith (HWS) Colleges.
See template
See template
Hotel Direct Bill Authorization Form
PDF template
Form for authorizing direct hotel billing for business-related travel and stays at Hobart and William Smith (HWS) Colleges.
See template
See template
Exemption Certificate
PDF template
A form for federal employees to certify tax-exempt purchases made on behalf of their government agency.
See template
See template
Hourly Time Sheet Form
PDF template
A form for tracking employee work hours, client activities, and mileage for a service organization.
See template
See template
Household Report Form
PDF template
Official form for reporting household information to determine public assistance benefits in Minnesota.
See template
See template
How To Submit A Claim For Critical Illness, Accident And Hospital Indemnity Insurance
PDF template
Comprehensive guide for filing insurance claims for critical illness, accident, and hospital indemnity coverage with The Hartford.
See template
See template
Short Term Disability Claim Form
PDF template
Instructions for filing a short-term disability insurance claim through Mutual of Omaha, detailing submission methods and required sections.
See template
See template
Employee Travel Authorization Settlement Form
PDF template
Comprehensive guide for employees to complete a travel authorization and expense settlement document for organizational travel.
See template
See template
Stationary Order Form
PDF template
Step-by-step guide for employees to order business cards, stationary, and name badges through the SLCC employee portal.
See template
See template
UCR Retiree Association Membership Information
PDF template
Comprehensive guide for University of California, Riverside retirees outlining membership benefits, access, and how to join the retiree association.
See template
See template
Purchase Approval Form
PDF template
Document outlining purchase approval limits and required documentation for agency purchases under different monetary thresholds.
See template
See template
Accident Investigation Report
PDF template
A comprehensive form for documenting workplace accidents, including details of injury, witness statements, and reporting procedures.
See template
See template
Declaration Of Payroll Deduction
PDF template
Form for employees to authorize payroll deductions for retirement accounts, contributions, and miscellaneous purposes.
See template
See template
HR 310, Volunteer Time Off (VTO) Policy
PDF template
Policy outlining paid volunteer time for employees of Upper Iowa University to engage in community service with nonprofit organizations.
See template
See template
Partnership For Children Of Cumberland County, Inc. Human Resources Policies And Procedures
PDF template
Policy outlining reimbursement guidelines for work-related travel expenses for employees of Partnership for Children of Cumberland County.
See template
See template
EXIT INTERVIEW
PDF template
A comprehensive interview form for employees leaving an organization, capturing insights about their work experience and reasons for departure.
See template
See template
HR 8 Leave Request Form
PDF template
A form for employees to request and allocate leave hours across different leave types for a specific pay period.
See template
See template
Health Reimbursement Arrangement (HRA) Claim Form
PDF template
Claim form for health reimbursement arrangements for members of Operating Engineers Local #49, used to request reimbursement for eligible healthcare expenses.
See template
See template
Health Reimbursement Account (HRA) Claim Form
PDF template
A form for employees to submit healthcare expense reimbursement claims through their Health Reimbursement Account (HRA)
See template
See template
Spending Account Reimbursement Claim Form
PDF template
A comprehensive form for claiming reimbursements for healthcare, dependent day care, and transportation expenses through spending accounts.
See template
See template
REQUEST FOR REIMBURSEMENT FORM
PDF template
A form for submitting healthcare expense reimbursement requests through the Southern California Pipe Trades Health & Welfare Fund HRA program.
See template
See template
Health Insurance Claim Form
PDF template
A comprehensive medical insurance claim form for submitting healthcare service reimbursement or coverage details.
See template
See template
Change Of Address Form
PDF template
Document for employees to update their address for health benefits and pension purposes
See template
See template
Employee Evaluation Form
PDF template
A comprehensive form for assessing employee performance, strengths, goals, and development needs.
See template
See template
EmployeeS InjuryIllness Report Form
PDF template
A comprehensive form for documenting workplace injuries or illnesses at the Fashion Institute of Technology.
See template
See template
Employee Time Off Request
PDF template
A form for employees to request time off, to be submitted at least one week prior to the first day of leave.
See template
See template
FMLA LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request leave under the Family and Medical Leave Act (FMLA) for various qualifying reasons.
See template
See template
CSEA Leave Request Form
PDF template
A form for employees to request various types of leave from work, including sick, vacation, personal, and other leave types.
See template
See template
MSC Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave from their employer, covering sick, vacation, personal, and specialized leave types.
See template
See template
Supplemental Insurance Cancellation Form
PDF template
A form for employees to cancel pre-tax and post-tax supplemental insurance deductions with specified effective date.
See template
See template
Sample Employee Resignation Form
PDF template
A comprehensive guide for managing employee resignation or termination processes, covering administrative, legal, and IT-related tasks.
See template
See template
Open Enrollment And HR Benefits Communication
PDF template
Document covering open enrollment period, CARES Act unemployment information, and employee performance evaluation process for 2020.
See template
See template
HSA Payroll Deduction Form
PDF template
Employee form for setting up pre-tax payroll deductions to a Health Savings Account (HSA) through Grand Rapids Community College.
See template
See template
SUNY GENESEO LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave, including Family Medical Leave, Paid Family Leave, and Parental Leave.
See template
See template
SUNY Geneseo Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including FMLA, NYS Paid Family Leave, and NYS Paid Parental Leave
See template
See template
Changing Your Name AndOr Address
PDF template
Comprehensive guide detailing the forms and departments employees must notify when changing personal information such as name or address.
See template
See template
Earned Time Off Policy
PDF template
A comprehensive policy detailing how employees can use and request earned time off for various personal and medical reasons.
See template
See template
VOLUNTEER TIME OFF PROGRAM AND POLICY
PDF template
Policy detailing employee volunteer time off program allowing up to 40 hours per year for nonprofit volunteering with paid time off.
See template
See template
STAFF PARENTAL LEAVE REQUEST FORM
PDF template
A form for employees to request parental leave, specifying extended or short-term leave options and anticipated leave duration.
See template
See template
Performance Review Form Hourly Employees
PDF template
A comprehensive performance review form for evaluating hourly employees across competencies and performance expectations.
See template
See template
Performance Assessment Form For Classified Exempt Employees
PDF template
A standardized form for evaluating performance of classified and non-classified employees at Marshall University
See template
See template
Wellness Program Reimbursement Form
PDF template
Form for full-time employees to request up to $50 annual reimbursement for health and fitness program costs for themselves and dependents.
See template
See template
Claim Form
PDF template
A form for seeking reimbursement of eligible out-of-pocket expenses with participant certification and submission instructions.
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
Form for employees of Knox College to designate salary reduction contributions to a Health Savings Account (HSA) for the plan year 2024.
See template
See template
HSA Contribution Form
PDF template
A form for employees to adjust their Health Savings Account contributions through payroll deductions, specifying contribution amounts and frequency.
See template
See template
Health Savings Account 2023 Payroll Deduction Contribution Form
PDF template
Form for employees to start, stop, or change Health Savings Account (HSA) contributions through payroll deductions.
See template
See template
Health Savings Account 2024 Payroll Deduction Contribution Form
PDF template
Form for employees to start, stop, or change Health Savings Account (HSA) contributions through payroll deductions for the 2024 plan year.
See template
See template
HEALTH SAVINGS ACCOUNT Voluntary Contribution Designation
PDF template
University of Arizona form for employees to voluntarily designate contributions to their Health Savings Account
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
A form for employees to enroll in and specify Health Savings Account (HSA) contributions, including eligibility requirements and tax considerations.
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
A form for employees to authorize salary reduction for Health Savings Account contributions under a High Deductible Health Plan
See template
See template
Health Savings Account Employer Contribution Form
PDF template
A form for employers to make contributions to employee Health Savings Accounts with specific contribution details and authorization.
See template
See template
HEALTH SAVINGS ACCOUNT EMPLOYER CONTRIBUTION FORM
PDF template
A form for employers to make contributions to employee Health Savings Accounts (HSAs) with details for initial and subsequent contributions.
See template
See template
HSA Enrollment Form
PDF template
A form for employees to enroll in a Health Savings Account (HSA) with employer contribution and payroll deduction options.
See template
See template
Oberlin College Employer Contribution Amounts Health Savings AccountHealth Reimbursement Account
PDF template
Document detailing Oberlin College's employer contributions to Health Savings Accounts and Health Reimbursement Accounts for different employee categories in 2023.
See template
See template
Health Savings Account (HSA) Payroll Deduction Form
PDF template
A form for employees to establish, change, or stop payroll deductions for their health savings account (HSA)
See template
See template
HSA Payroll Deduction Authorization Form
PDF template
Form for employees to authorize payroll deductions for health savings account contributions through the City of Wisconsin Rapids.
See template
See template
Employee HSA Payroll Deduction Form
PDF template
Form for employees to authorize payroll deductions for health savings account contributions with detailed contribution limits and eligibility information.
See template
See template
Health Savings Account Payroll Deduction Form
PDF template
Form for employees to set up payroll deductions for a Health Savings Account with High Deductible Health Plan coverage details.
See template
See template
HSA Reimbursement Form
PDF template
A form for requesting reimbursement of medical, prescription, dental, or vision expenses from a Health Savings Account managed by HealthEquity.
See template
See template
HSA Reimbursement Form
PDF template
A form for requesting reimbursement from a Health Savings Account for medical, prescription, dental, or vision expenses.
See template
See template
HSA Reimbursement Form
PDF template
A form for requesting reimbursement for medical, prescription, dental, or vision expenses from a health savings account.
See template
See template
Disciplinary Action Form
PDF template
A formal document used to record and track employee performance issues, misconduct, and potential disciplinary actions at the University Health Science Center.
See template
See template
COVID 19 Hold Harmless DIRECTIVE Frequently Asked Questions (FAQ)
PDF template
Guidance for stakeholders and service providers on contract agreements and payments during COVID-19 pandemic.
See template
See template
Discretionary Residency Benefit Application Form
PDF template
Financial assistance program for Ontario Works and ODSP recipients who are homeless, at risk of homelessness, or moving to more affordable housing.
See template
See template
State University Of New York Medical Reimbursement Form Claims Incurred Outside Of The United States
PDF template
A medical reimbursement form for SUNY employees and members to claim medical expenses incurred outside the United States.
See template
See template
Prescription Reimbursement Form
PDF template
A form for submitting prescription drug expenses for insurance reimbursement, requiring patient and prescription details.
See template
See template
HUDESGSTEHP ES PREV DISCHARGE
PDF template
A form used to collect universal data elements and income/benefits information when a client exits a homeless shelter or prevention program.
See template
See template
Claim For Temporary Relocation Expenses (Residential Moves)
PDF template
Official U.S. Department of Housing and Urban Development form for claiming reimbursement of temporary relocation expenses for residential moves.
See template
See template
Residential Claim For Moving And Related Expenses
PDF template
A government form for claiming reimbursement of residential moving expenses under the Uniform Relocation Assistance and Real Property Acquisition Policies Act.
See template
See template
AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)
PDF template
A form for employees to authorize automatic electronic deposits of funds into their bank accounts by the College.
See template
See template
Huu Ay Aht First Nations Event Agreement Form
PDF template
A form outlining participation requirements and expense reimbursement for Huu-ay-aht First Nations citizens attending events.
See template
See template
Healthcare Worker Bonus Employee Inquiry Form Instructions
PDF template
Form for healthcare workers to apply for bonus eligibility by providing employment and qualification details.
See template
See template
Hy Flex Attendance Certification Form
PDF template
Form for documenting in-classroom attendance for hy-flex courses to maintain VA education benefits eligibility.
See template
See template
Disciplinary Action Form
PDF template
A standard form for documenting workplace misconduct and corresponding disciplinary measures for employees.
See template
See template
Record Of Employment
PDF template
A form for documenting employment status for unemployment insurance purposes in New York State.
See template
See template
Record Of Employment
PDF template
A form for documenting employment details for unemployment insurance claims in New York State.
See template
See template
Employee Classification And Hiring Processes Audit Report 19 02
PDF template
An internal audit examining the Department's human resources hiring processes, job classification reviews, and associated procedural effectiveness.
See template
See template
National Pension Fund Plan C
PDF template
A pension fund document listing trustees, executive directors, fund counsel, and consultants for the International Alliance of Theatrical Stage Employees (IATSE) pension plan.
See template
See template
Pension Plan Document
PDF template
Comprehensive document outlining the structure, benefits, and operational details of a pension plan for employees.
See template
See template
Employee Emergency Contact Form
PDF template
A form for collecting employee personal and emergency contact details for workplace safety and emergency response purposes.
See template
See template
EMPLOYEE LEAVE REQUEST FORM
PDF template
A form for employees to request time off, specifying leave type, dates, and obtaining supervisor approval.
See template
See template
ICPP 10 Handbook And JPP Grant Program Proof Of Purchase Form
PDF template
A form for documenting purchases of handbook sets, conference registrations, and requesting grant reimbursements for the ICPP-10 Conference.
See template
See template
Simple Printable Expense Report Form
PDF template
A form for employees to document and submit work-related expenses for reimbursement.
See template
See template
ICSVEBA 2021 Back To School E Kit Guide
PDF template
Comprehensive benefits enrollment guide for San Pasqual Valley Unified School District employees for the 2021-2022 school year
See template
See template
Federal Employees Health Benefits (FEHB) Premium Conversion Election Form
PDF template
Form for federal employees to elect or waive pre-tax treatment of health insurance premium contributions.
See template
See template
IEEE Houston Section Travel Policy
PDF template
Comprehensive travel policy detailing reimbursement guidelines and expense rules for IEEE Houston Section members on official business.
See template
See template
IEEE Expense Report Form Instructions
PDF template
Comprehensive instructions for completing an IEEE expense report, covering data entry, protected fields, and expense tracking procedures.
See template
See template
INDIVIDUAL AND FAMILY GROUP TERM LIFE INSURANCE
PDF template
Comprehensive employer manual detailing group term life insurance policy guidelines, coverage, enrollment, and claims processing.
See template
See template
PCARD PURCHASE FORM
PDF template
A form for documenting and tracking purchases made using an organizational purchase card with specific spending limits and guidelines.
See template
See template
Employee SystemsAccess Checklist Form
PDF template
A form for tracking and managing system access and resources for new or transitioning employees in an educational or administrative setting.
See template
See template
Procedure III.3001.G.A, Employee Travel
PDF template
Comprehensive policy governing official college travel, including expenditure guidelines, approval processes, and reimbursement procedures for employees.
See template
See template
IncidentHazard Report Program
PDF template
A comprehensive program for employees to report workplace hazards and potential safety risks within county departments.
See template
See template
Inactive Employee Change Of Address Form
PDF template
Form for updating mailing address for inactive employees at George Washington University for W2 tax purposes.
See template
See template
Inactive Employee Change Of Address Form
PDF template
Form for inactive employees to update their mailing address for W2 tax documents at George Washington University.
See template
See template
Workplace Violence Incident Investigation Form
PDF template
A comprehensive form for documenting and investigating workplace violence incidents, including details about the event, parties involved, and preventative recommendations.
See template
See template
Incident Report
PDF template
A comprehensive form for documenting workplace incidents, accidents, and potential injuries at Upper Merion Township.
See template
See template
Employee, Volunteer Youth AccidentIncident Report Form
PDF template
A comprehensive form for documenting accidents, incidents, and injuries involving employees, volunteers, and youth participants at the University of Kentucky Cooperative Extension Service.
See template
See template
Employee, Volunteer Youth AccidentIncident Report Form
PDF template
A comprehensive form for documenting accidents, incidents, and injuries involving employees, volunteers, and youth participants at the University of Kentucky Cooperative Extension Service.
See template
See template
Income Tax Withholding Instructions
PDF template
Instructions for employees on state and federal tax withholding procedures and submission requirements for Occidental Petroleum Corporation.
See template
See template
Conference Travel Guidance Document
PDF template
Detailed instructions for submitting and tracking travel expenses for conference travel within the Department of Children and Families (DCF)
See template
See template
How To Use Your New Caremark Prescription Drug Program
PDF template
Guide explaining new prescription drug coverage details for county employees through Caremark beginning January 1, 2011.
See template
See template
Molloy University EmployeeIndependent Contractor Checklist
PDF template
A form used to determine whether an individual should be classified as an employee or independent contractor at Molloy University.
See template
See template
Section 900 INDEX
PDF template
Comprehensive index of employee policies and workplace guidelines for a county government organization.
See template
See template
Individual Reimbursement Form
PDF template
A comprehensive form for processing individual reimbursements and verifying employment and citizenship status for the Texas A&M University System.
See template
See template
JOINT PROMOTIONAL PROGRAM INVOICE FORM
PDF template
Invoice form for submitting grant-related expenses by a tourism grantee for reimbursement from the New Hampshire Division of Travel and Tourism Development.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider, detailing patient, pharmacy, and insurance information.
See template
See template
Initial Interview Form
PDF template
A comprehensive form for veterans and their family members to collect information needed to apply for veterans' benefits.
See template
See template
Louisiana State Employees Retirement System Purchase Of Service Credit For Military Service
PDF template
Proposed amendments to retirement system rules regarding military service credit purchase, aligning with federal and state regulations.
See template
See template
Risk Assessment For Hazardous Agents And Animal Contact
PDF template
A comprehensive form for evaluating occupational health risks associated with hazardous agents and animal contact in a research environment.
See template
See template
Injury Incident Report Workers Compensation
PDF template
A form documenting workplace injury incidents with no medical treatment required, used for tracking workplace safety and potential compensation claims.
See template
See template
Reimbursement Account Claim Form
PDF template
Claim form for submitting healthcare and dependent care expenses for reimbursement through a flexible spending account or reimbursement account.
See template
See template
Individual Request For Approval For Out Of State Travel
PDF template
A form for university employees to request approval and document details for out-of-state travel
See template
See template
Food Purchase Form Guide
PDF template
Comprehensive guide for completing a food purchase form, detailing required information and step-by-step instructions for submission.
See template
See template
Instructions For Invoicing For Juvenile Justice Education Special Appropriation 103 Funds
PDF template
Detailed instructions for providers to submit reimbursement invoices for high school equivalency and postsecondary education services for juvenile justice programs.
See template
See template
Mileage Expense Report
PDF template
A form for employees to report and request reimbursement for business-related travel miles.
See template
See template
E Sahaj Sewa User Registration Instructions
PDF template
Instructions for registering and obtaining security clearance for individuals from countries bordering India applying for Director Identification Number (DIN)
See template
See template
Reimbursement Form For Non Travel Related Expenses
PDF template
A form for obtaining reimbursement for non-travel related expenditures at Morgan State University with detailed submission guidelines.
See template
See template
Health Insurance Proposal Form
PDF template
A comprehensive health insurance proposal form for organizations to select insurance coverage for employees and their families.
See template
See template
EMPLOYEE WAIVER OF HEALTH INSURANCE FORM
PDF template
Form for employees to waive group health insurance coverage due to alternative coverage.
See template
See template
DELL COMPUTER REQUEST FORM
PDF template
Official form for requesting Dell computer products for university departments, with specific instructions for processing and approval.
See template
See template
IntakeReferral Form
PDF template
A form for reporting workplace incidents, complaints, or potential misconduct within a Tennessee state agency.
See template
See template
Refund Request Form
PDF template
A form for requesting refunds for conference or membership-related expenses with multiple reason options.
See template
See template
Orthopaedic Surgery Program Intent To Travel Form
PDF template
A form for documenting and requesting travel reimbursement for residents in the Orthopaedic Surgery Program with details about mileage and funding sources.
See template
See template
Interim Evaluation Form
PDF template
A form for documenting an employee's interim performance review, highlighting areas of achievement and improvement.
See template
See template
Internal Employee Transfer Request Form
PDF template
A form for employees to request an internal transfer to an open position within the organization.
See template
See template
Internal Mobility Applicant Interview Form
PDF template
A detailed form for collecting employment history, qualifications, and performance information for internal job mobility candidates.
See template
See template
Internal Transfer Request Form
PDF template
A formal document for employees seeking to transfer to another position within an organization, outlining required procedures and qualifications.
See template
See template
Employee Direct Deposit Authorization Form
PDF template
A form for employees to authorize direct deposit of their paychecks into one or two bank accounts by providing account details and signature.
See template
See template
Application Form For Invalidity Pension
PDF template
Official government form for applying for Invalidity Pension in Ireland, with detailed instructions for completion.
See template
See template
Investigation Checklist Form
PDF template
A structured guide for conducting neutral and confidential workplace investigations into employee complaints or harassment concerns.
See template
See template
Invoice Form
PDF template
A form for documenting consultant services and payment details for the Institute for Human Development at UMKC.
See template
See template
INVOICE FORM LITIGATION AND LEGAL INTERVENTIONS
PDF template
Form for requesting reimbursement of legal and administrative expenses from the CCP with detailed expense categories and rate limitations.
See template
See template
INVOICE FORM TEST CASE DEVELOPMENT
PDF template
Invoice form for requesting reimbursement of legal and administrative expenses from the CCP with specified expense categories and rate limitations.
See template
See template
Completing The Invoice Supporting Documentation Packet
PDF template
Guidelines for submitting supporting documentation with grant invoices, including preparation steps and document requirements.
See template
See template
Invoicing For Foster Parent Travel (Receiving Per Diem)
PDF template
Detailed guidelines for foster parents to invoice and log reimbursable travel expenses related to foster children.
See template
See template
Invoicing For Relative Placement Travel (NOT Receiving Per Diem)
PDF template
Guide for completing travel invoices for relative placement travel with detailed mileage reimbursement instructions.
See template
See template
Incident Report Form
PDF template
A standardized form for documenting workplace incidents, injuries, or damages involving employees or volunteers.
See template
See template
Income Related Monthly Adjustment Amount (IRMAA) Reimbursement Form
PDF template
Form for New York City retirees to request reimbursement for Medicare Part B income-related monthly adjustment amount premiums.
See template
See template
Medicare Part B IRMAA Reimbursement Form
PDF template
Form for reimbursing Medicare-eligible retirees and dependents for additional Medicare Part B income-related monthly adjustment amount (IRMAA) premiums.
See template
See template
Medicare Part B Income Related Monthly Adjustment Amount (IRMAA) Reimbursement Form
PDF template
Form for NYC employees to request reimbursement for Medicare Part B premiums exceeding standard monthly amounts.
See template
See template
Medicare Part B And Part D Premium Reimbursement Notice
PDF template
Notice for New Jersey retirees about potential reimbursement for Medicare Part B and Part D premium surcharges paid in 2023.
See template
See template
Impairment Related Work Expense Request
PDF template
Form for reporting work-related expenses for Social Security disability beneficiaries to potentially offset income calculations.
See template
See template
Information Technology Project Request Form
PDF template
A comprehensive form for submitting and evaluating technology project proposals within an organization
See template
See template
ITEMIZED SCHEDULE OF TRAVEL EXPENSES
PDF template
Official form for documenting and claiming travel-related expenses for state employees and board/commission members.
See template
See template
IT Addendum To ContractorS Contract Form
PDF template
An addendum modifying standard contract terms for IT services between a contractor and the Virginia Community College System (VCCS)
See template
See template
CDW Customer Service Order Form
PDF template
Agreement between Tulsa County and CDW Government, LLC for Mimecast M2A and LCS-Gold annual subscriptions
See template
See template
ITC F.A.Q. Travel Requests
PDF template
Comprehensive guidelines for travel request submissions, reimbursement procedures, and documentation requirements for ITC grant-related travel.
See template
See template
Reimbursement Of Expenses Policy
PDF template
Policy establishing guidelines for reimbursement of expenses for Commissioners and Advisory Committee Members of the First 5 Commission of San Diego County.
See template
See template
GOLD COAST TRANSIT TRAVEL OTHER EXPENSE REPORT FORM
PDF template
A form for employees to report and request reimbursement for travel and miscellaneous expenses.
See template
See template
GOLD COAST TRANSIT TRAVEL OTHER EXPENSE REPORT FORM
PDF template
A form for documenting employee travel expenses and reimbursement claims for Gold Coast Transit.
See template
See template
GOLD COAST TRANSIT TRAVEL OTHER EXPENSE REPORT FORM
PDF template
Detailed expense report for employee Steven Brown documenting travel expenses to a California Transit Association Conference.
See template
See template
I.T Maintenance Request Form
PDF template
A form used to document and track IT equipment maintenance requests within an organization.
See template
See template
ITP 3 Technology Governance And Procurement Review
PDF template
Administrative procedure defining the technology governance process and requirements for technology procurement review at Marshall University.
See template
See template
Information Technology Professional Services Agreement
PDF template
A service agreement between Cornell University and a technology consultant for professional IT services and deliverables.
See template
See template
SIUE ITS Network Infrastructure Management Service Requisition Form
PDF template
A form for requesting network and infrastructure services at Southern Illinois University Edwardsville (SIUE)
See template
See template
Information Technology Services Purchase Requisition Form
PDF template
Guidelines for staff to request and purchase IT equipment through the Information Technology Services department's requisition process.
See template
See template
Payroll Deduction Authorization Form
PDF template
Form for employees to authorize ongoing or one-time payroll deductions to the Wesleyan Fund
See template
See template
Change Of Contact Form
PDF template
A form for healthcare providers to update their contact information and cost report filing details.
See template
See template
Jewish Communal Professional (JCP) Tuition Credit Application Form
PDF template
Application form for Jewish organization employees seeking tuition credit for the school year.
See template
See template
JDRF 2023 ChildrenS Congress Travel Expense Reimbursement Policy
PDF template
Guidelines for volunteer travel expense reimbursement for JDRF Children's Congress event, including transportation and meal allowances.
See template
See template
Faculty Conference Travel Instructions
PDF template
Comprehensive guidelines for Holy Cross faculty members planning conference travel, detailing required forms, submission procedures, and travel arrangements.
See template
See template
Job Related Training And Education Employee Request Form
PDF template
Form for employees to request tuition reimbursement and time off for job-related educational programs at UTHealth.
See template
See template
University SystemEmployee Intellectual Property Joint Participation MUSP 407
PDF template
A form for university employees to seek approval for intellectual property arrangements involving business entities and potential conflicts of interest.
See template
See template
Journal Reimbursement Form
PDF template
A form for requesting reimbursement for journal-related business expenses with certification of expenses.
See template
See template
Member Claim Form
PDF template
A medical insurance claim form used to submit healthcare service expenses for reimbursement by Anthem Blue Cross health plan.
See template
See template
Authorization, Agreement, And Certification Of Training
PDF template
A comprehensive document for recording employee training details, course information, and agency-specific training data.
See template
See template
HR Change Of Address Form
PDF template
A form for employees to update their personal contact information and notify benefits vendors of address changes.
See template
See template
JSU Travel Reimbursement Form Instructions
PDF template
Detailed instructions for completing a travel reimbursement form, covering per diem, lodging, and mileage expenses.
See template
See template
Judicial Branch Expense Account Form Instructions
PDF template
Detailed instructions for completing an expense account form for judicial branch employees, covering travel reimbursement and personal information submission.
See template
See template
2022 Partnership Expense Report Form
PDF template
Guidelines for expense reimbursement for HIV Partnership members participating in meetings and designated events.
See template
See template
Transitions
PDF template
Monthly update document from Massachusetts Department of Transitional Assistance covering case transfer functionality, MBTA fare changes, and participation form guidelines.
See template
See template
Juror Reimbursement Form
PDF template
Official form for jurors to document and request reimbursement for expenses incurred while serving in federal court.
See template
See template
Jury DutyPre Trial Attendance Form
PDF template
Form for documenting an employee's attendance and time spent for jury duty or pre-trial proceedings.
See template
See template
KPERS 15B Direct Deposit Agreement
PDF template
Form for setting up direct deposit of retirement benefits with Kansas Public Employees Retirement System
See template
See template
DESIGNATION OF BENEFICIARY FOR LIFE INSURANCE KANSAS BOARD OF REGENTS MEMBERS
PDF template
Official form for Kansas Board of Regents members to designate life insurance beneficiaries for KPERS insurance benefits.
See template
See template
Kentucky Assigned Claims Plan Billing Summary Form
PDF template
A detailed form for submitting reimbursement requests and subrogation recoveries for insurance claims in Kentucky's Assigned Claims Plan.
See template
See template
Kentucky Assigned Claims Plan Billing Summary Form
PDF template
Detailed guide for insurers on submitting reimbursement requests and subrogation details for the Kentucky Assigned Claims Plan.
See template
See template
California Region Group EnrollmentChange Form
PDF template
A form for employers to enroll employees and their dependents in health insurance coverage or make changes to existing coverage.
See template
See template
Member Reimbursement Form For Medical Claims
PDF template
A comprehensive form for submitting medical claim reimbursement requests, including patient and provider details.
See template
See template
Peralta Community College District Reimbursement Form
PDF template
Form for Peralta Community College District employees and retirees to claim medical expense reimbursements based on specific eligibility criteria.
See template
See template
COVID 19 Leave Request Form
PDF template
Form for Kansas Department of Transportation employees to request leave related to COVID-19 testing and isolation
See template
See template
KeyAccess Card Request Form
PDF template
Form for requesting keys and access cards for college employees, outlining access and usage requirements.
See template
See template
Key Electronic Access Request Form
PDF template
Form for requesting building, room, and electronic access for employees at an organization, including key and FOB/PROX card requests.
See template
See template
KEY AUTHORIZATION FORM FOR FAU JUPITER CAMPUS KEY(S)
PDF template
A form for requesting and tracking key issuance to employees at Florida Atlantic University's Jupiter Campus, detailing key distribution and return procedures.
See template
See template
KEY (ACCESS) REQUISITION
PDF template
Form used to request new keys or access changes for employees at an educational institution
See template
See template
KMF Expense Reimbursement Application
PDF template
A form for submitting expense reimbursement requests for community service and outreach projects by the Kent Medical Foundation.
See template
See template
Employee Travel Expense Guidelines
PDF template
Comprehensive guidelines for University of Georgia employees on travel expense submission, per diem rates, and reimbursement procedures.
See template
See template
Aflac Cancer Wellness Claim Form
PDF template
Document providing guidance on filing wellness claims with Aflac insurance and information about Primary Care Provider (PCP) selection.
See template
See template
My Benefits Manager Provider Portal Guide
PDF template
A comprehensive guide for healthcare providers to navigate the My Benefits Manager portal for claims, eligibility, and authorization management.
See template
See template
Member Reimbursement Form For Over The Counter COVID 19 Tests
PDF template
A form for Kaiser Permanente members to request reimbursement for over-the-counter COVID-19 test purchases.
See template
See template
KPERS Retirement Application
PDF template
Comprehensive guide and application for retirement benefits through the Kansas Public Employees Retirement System (KPERS)
See template
See template
2025 Value Added Benefits
PDF template
Comprehensive benefits guide for pregnant and new mothers, offering rewards, support programs, and additional healthcare services.
See template
See template
KUDOS Nomination Form
PDF template
A form for nominating employees in the Office of Human Resources for outstanding performance in specific award categories.
See template
See template
Campus Kudos Nomination Form
PDF template
A form for recognizing and nominating UNM-Gallup employees who demonstrate exceptional service and positive behaviors.
See template
See template
Benefit Application Form For Ontario Works
PDF template
A comprehensive application form for accessing various social assistance benefits and support services in Ontario, specifically for Gull Bay First Nation.
See template
See template
CAMERON UNIVERSITY LEAVE REQUEST FORM
PDF template
A form for employees to request various types of leave including vacation, sick, or special leave at Cameron University.
See template
See template
Application For Pension
PDF template
Comprehensive pension application package for laborers seeking to start their pension benefit, including forms and instructions for benefit election.
See template
See template
Bessie Marshall Benefit Fund Instructions
PDF template
Detailed instructions for members to apply for weekly benefits in case of sickness or injury, with specific eligibility requirements and limitations.
See template
See template
Ladies Auxiliary To The Maryland State FiremenS Association Bessie Marshall Benefit Fund Instructi
PDF template
Benefit fund guidelines for sick or injured members of the Maryland State Firemen's Association providing weekly financial assistance under specific conditions.
See template
See template
PROOF OF DISABILITY CLAIM FORM
PDF template
A form for employees to document and claim disability benefits through the Labor Alliance Managed Trust Fund.
See template
See template
Continuing Studies Appointment Form
PDF template
A comprehensive form for new employee appointments and continuing studies staff documentation at Langara College.
See template
See template
Reimbursement Of Overdue Expense Reports Overview
PDF template
Policy detailing how University of Michigan faculty and staff can submit reimbursement for business expenses incurred before October 14, 2009.
See template
See template
STUDENT ORGANIZATION REIMBURSEMENT REQUEST FORM
PDF template
A form for student organization members to request reimbursement for pre-approved purchases related to organizational events.
See template
See template
Associate Payroll Deduction Form
PDF template
A form for employees to authorize recurring or one-time payroll deductions for charitable contributions.
See template
See template
Travel Reimbursement Request
PDF template
A form for employees to request reimbursement for travel-related expenses including transportation, lodging, meals, and other costs.
See template
See template
Claim Form Unclaimed Funds Over Three Years Old
PDF template
A form for claiming unclaimed funds held by the City of La Caada Flintridge that are over three years old.
See template
See template
LDSS 2642 Documentation Requirements
PDF template
A form detailing documentation needed to prove various eligibility factors for social services or benefits application.
See template
See template
LE 13 Training Reimbursement For License Exempt Family Child Care Providers
PDF template
Reimbursement form for license exempt family child care providers to get up to $300 for professional training and education.
See template
See template
Department Leave Audit Form
PDF template
A comprehensive form for auditing and documenting employee leave balances, accruals, and usage within a department.
See template
See template
Annual Leave Contribution Record
PDF template
A form for employees to voluntarily contribute annual leave hours to classified or administrative leave banks at the university.
See template
See template
NIH Leave Bank Policies And Procedures
PDF template
A program offering income protection for NIH employees experiencing medical emergencies by allowing leave donations between employees.
See template
See template
Leave Request Form
PDF template
A form for employees to request leave under FFCRA, ADA, or discretionary leave policies related to COVID-19 circumstances.
See template
See template
Leave Request Form
PDF template
A comprehensive form for Wellesley Public Schools employees to request various types of leave of absence.
See template
See template
LEAVE OF ABSENCE REQUEST FORM
PDF template
Detailed guidelines for employees requesting a leave of absence, including required documentation for various types of leave.
See template
See template
LEAVE REQUEST FORM
PDF template
A form for employees to request various types of leave including personal, vacation, sick, bereavement, and other leave types.
See template
See template
Leave Request Form
PDF template
A form for employees to request various types of leave, including family medical, annual, compensatory, and sick leave.
See template
See template
Leave Request And Approval
PDF template
Official form for requesting and documenting various types of employee leave in the Alabama Unified Judicial System
See template
See template
EMPLOYEE LEAVE REQUEST FORM
PDF template
Procedural guidelines for employees to request leave, including submission, supervisor approval, and HR processing steps.
See template
See template
Leave Request Form
PDF template
Form for employees to request paid family and sick leave under COVID-19 emergency provisions.
See template
See template
Middlesex Community College Leave Request Form
PDF template
A form for employees to request various types of leave and obtain supervisor approval at Middlesex Community College.
See template
See template
K State Student Union Leave Request Form
PDF template
A form for employees to request time off, documenting leave details and supervisor approval.
See template
See template
Leave Request Form
PDF template
A form for employees to request time off, specifying type and duration of leave.
See template
See template
Leave Request Form 12 Month Employees
PDF template
A form for 12-month employees to request and document different types of leave, including vacation, sick leave, and family medical leave.
See template
See template
COVID19 Leave Request Form
PDF template
A form for employees to request leave related to COVID-19 public health emergency situations
See template
See template
Leave Request Form
PDF template
A form for employees of Huron-Superior Catholic District School Board to request various types of leave and time off.
See template
See template
Leave Request Form
PDF template
A comprehensive form for employees to request various types of leave, including annual, sick, compensatory, military, and witness/jury leave.
See template
See template
LEAVE REQUEST FORM
PDF template
A form for employees to document and request various types of leave including vacation, sick leave, and special leave.
See template
See template
Leave Request Form Management
PDF template
A comprehensive form for employees to request various types of leave, including medical, family, and parental leave.
See template
See template
NAUSET PUBLIC SCHOOLS LEAVE REQUEST FORM
PDF template
A comprehensive form for Nauset Public Schools employees to request various types of leave, including personal, sick, vacation, and other leave types.
See template
See template
LEAVE REQUEST FORM
PDF template
A form for employees to request time off work for various leave types including vacation, sick leave, and personal leave.
See template
See template
Vacation Personal Leave Request
PDF template
Form for employees to request vacation or personal leave time with supervisor approval
See template
See template
Leave Request Form
PDF template
A form for employees to request time off, including vacation, unpaid leave, or other types of leave.
See template
See template
LEAVE REQUEST FORM UWUA
PDF template
A form for employees to request various types of leave, including medical, personal, and family care leaves.
See template
See template
CORVALLIS SCHOOL DISTRICTLEAVE REQUEST
PDF template
A comprehensive form for employees to request various types of leave, including bereavement, professional, sick, and vacation leave.
See template
See template
Time Off Request Policy
PDF template
Comprehensive policy and form detailing the process for employees to request and document various types of leave from their organization.
See template
See template
Transportation Time Off Request Form
PDF template
A form for transportation employees to request time off, with specific guidelines for drivers and monitors.
See template
See template
CITY OF SOCORRO LEAVE REQUEST FORM
PDF template
A comprehensive form for employees to request various types of leave and for HR to track and approve leave requests.
See template
See template
UNC Lecturer Visitor Travel And Reimbursement Workflow
PDF template
Workflow diagram for processing visiting lecturers, including travel reimbursement, forms, and eligibility checks based on citizenship and compensation status.
See template
See template
Leer Inc. Walk In Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for walk-in units, capturing customer, job site, service provider, and reimbursement information.
See template
See template
Legal Dependent Verification Form
PDF template
Form for students to verify and document support for children or legal dependents for financial aid purposes.
See template
See template
ARAG Legal Insurance LLNS Benefit Program Summary
PDF template
Summary of legal insurance benefits for employees and retirees under the LLNS Health and Welfare Benefit Plan
See template
See template
ARAG Legal Insurance LANS Benefit Program Summary
PDF template
Summary of legal insurance benefits for LANS employees and retirees, effective January 1, 2017.
See template
See template
LEP Budget Spending Procedures
PDF template
Comprehensive guide for student groups on budgeting, fund spending, procurement, and vendor management procedures.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for employees to file a disability claim, documenting injury/illness details, personal information, and income sources.
See template
See template
Simple IRA Salary Reduction Agreement Form
PDF template
A form for employees to make salary reduction elections for their SIMPLE IRA retirement plan contributions.
See template
See template
Extra Duty And Overtime Timesheets Instructions
PDF template
Detailed instructions for employees to complete and submit extra duty and overtime timesheets for payment processing.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for employees to report disability, injury, or illness for benefits claim purposes.
See template
See template
TCC Child Care Assistance Program Attendance Verification Form
PDF template
A form for child care providers to document and verify child attendance for reimbursement through the TCC Child Care Assistance Program.
See template
See template
LIFE INSURANCE FORM
PDF template
A form for employees to designate primary and contingent life insurance beneficiaries with personal and contact information.
See template
See template
Group Term Life Insurance Enrollment Form
PDF template
An enrollment form for group term life insurance for employees, specifically for Episcopal Church clergy and employees
See template
See template
Retiree Life Cancellation Form
PDF template
Form for cancelling retiree life insurance coverage with UCM Benefits Group, with a warning that once cancelled, participation cannot be reinstated.
See template
See template
Beneficiary Designation Form
PDF template
A form for designating primary and contingent beneficiaries for an employee life insurance benefit plan.
See template
See template
Life Insurance Enrollment Form
PDF template
Insurance enrollment form for employees to select life and dependent life insurance coverage through Reliance Standard Life Insurance Company
See template
See template
PAID TIME OFF (PTO) REQUEST
PDF template
A form for employees to request and track paid time off (PTO) hours within the LifeWorks organization.
See template
See template
State Of Florida Group Long Term Disability Claim Form
PDF template
A comprehensive claim form for employees seeking long-term disability benefits through the State of Florida's insurance program administered by Cigna.
See template
See template
UNall HR Service Requests
PDF template
Comprehensive listing of HR service requests and forms available to UN staff members for various administrative and personal actions.
See template
See template
LLNS Prescription Drug Benefit For Anthem Members
PDF template
A summary of prescription drug benefits for Anthem members provided by CVS/Caremark, covering retail and mail-order pharmacy options.
See template
See template
Medium Term Loan Application Form
PDF template
A loan application form for bank employees seeking a medium-term loan from their cooperative society, requiring personal and employment details.
See template
See template
Leave Of Absence Request Form
PDF template
A comprehensive form for employees to request extended time off for various personal, medical, or family-related reasons.
See template
See template
Coronavirus Relief Fund Reimbursement Request Form
PDF template
A form for local governments in Alabama to request reimbursement for COVID-19 related expenses under the Coronavirus Relief Fund.
See template
See template
EQUIPMENT MACHINE EMISSION COMPLIANCE FORM (LL 77)
PDF template
A form for documenting and obtaining compliance for equipment and machine emissions in New York City
See template
See template
Local Membership Expense Claim Form
PDF template
A comprehensive expense claim form for Ontario Public Service Employees Union members to document and request reimbursement for various expenses.
See template
See template
Disability Claim Form FL
PDF template
A comprehensive form for filing a disability insurance claim with detailed sections for employer and employee information.
See template
See template
Long Term Disability Insurance For Judges Attorneys FAQs
PDF template
Informational document about long-term disability insurance options for New Mexico Judicial Branch judges and attorneys through Northwestern Mutual.
See template
See template
Combined Subsistence And Transportation Authorization And Expense Report
PDF template
Official city document for tracking and authorizing travel expenses for City of Omaha employees
See template
See template
Lost Receipt Affidavit
PDF template
Policy outlining procedures for submitting reimbursement requests when original receipts are lost, damaged, or unavailable.
See template
See template
Lost Warrant Affidavit Form
PDF template
A form used to request replacement of a lost or undelivered warrant/check from the college fiscal office.
See template
See template
LIMITED PURCHASE ORDER REQUEST FORM
PDF template
A form for requesting limited purchase orders for local purchases up to $5,000, used for immediate procurement of goods or services.
See template
See template
A.C.E Award Nomination Form
PDF template
A form for nominating employees for outstanding performance in specific professional categories.
See template
See template
LSO Reimbursement Form
PDF template
A form for law students to request reimbursement for business-related expenses incurred through a student organization.
See template
See template
Check And Expense Reimbursement Request Form
PDF template
A form for submitting expense reimbursement requests for the Lakeside School Parents and Guardians Association
See template
See template
Leave Travel Concession Rules
PDF template
Internal policy document detailing leave travel concession rules and guidelines for employees of Indraprastha Power Generation Company Limited and Pragati Power Company Limited.
See template
See template
Insurance Cancellation Request
PDF template
A form for employees to request cancellation of group insurance coverage, specifically long-term disability insurance.
See template
See template
Group LTD Insurance Cancellation Form
PDF template
Form for employees to cancel voluntary long-term disability insurance coverage with Tennessee Board of Regents
See template
See template
2024 LTD Change Form
PDF template
Form for employees to select or modify their Long-Term Disability (LTD) coverage options at the University of Rochester
See template
See template
Long Term Disability Claim Form
PDF template
A claim form for employees to submit long-term disability insurance claims with personal and medical information.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability insurance claim, requiring input from the member, plan sponsor, and attending physician.
See template
See template
Group Long Term Disability Claim Form
PDF template
A comprehensive claim form for employees seeking long-term disability benefits, requiring details from both the employee and attending physician.
See template
See template
Long Term Disability Claim Form Employer Statement
PDF template
Comprehensive employer statement form for filing a long-term disability insurance claim, capturing employee and claim details.
See template
See template
Long Term Disability Claim Form Statement Of Employer
PDF template
A form used by employers to submit details for an employee's long-term disability insurance claim with Lincoln Financial Group.
See template
See template
NRECA Long Term Disability Plan Summary Plan Description
PDF template
A comprehensive summary plan description detailing the long-term disability benefits provided by the National Rural Electric Cooperative Association for eligible participants.
See template
See template
ORPTSA Transfer Approval Form
PDF template
A form for Lamar University employees to transfer or rollover retirement accounts between vendors or plans
See template
See template
Changes To The Permanent Change Of Station (PCS) Authorization Process
PDF template
Department of the Interior memorandum detailing new procedures for creating Permanent Change of Station authorizations using the Financial and Business Management System (FBMS).
See template
See template
Digital Application For Contraception Management Member Reimbursement Form
PDF template
A form for members to request reimbursement for digital contraception management application subscriptions under their Blue Cross and Blue Shield of Minnesota plan.
See template
See template
Form M 1 Report For Multiple Employer Welfare Arrangements (MEWAs) And Certain Entities Claiming Exc
PDF template
A Department of Labor form for reporting multiple employer welfare arrangements and entities claiming exception to health coverage regulations.
See template
See template
Massachusetts EmployeeS Withholding Exemption Certificate
PDF template
State tax form for employees to claim withholding exemptions and personal tax information in Massachusetts
See template
See template
Medical Claim Form
PDF template
A form for submitting out-of-network medical claims for reimbursement by UnitedHealthcare for Pennsylvania members.
See template
See template
North Carolina Medicaid Aged, Blind And Disabled Medicaid Manual
PDF template
Guidelines for handling Medicaid application inquiries and documenting when an individual chooses not to apply for assistance.
See template
See template
MA Health Care Coverage Waiver Form
PDF template
Form for employees to decline employer-sponsored health insurance coverage with options for alternative coverage
See template
See template
Employee Emergency Contact Form
PDF template
A form for collecting employee contact details and emergency contact information in case of workplace emergencies.
See template
See template
Group Life Insurance Application
PDF template
Application for employees to select group life insurance coverage options for themselves and dependents.
See template
See template
Major Disaster Leave Request Form
PDF template
A form for employees to request leave due to major disaster impacts on themselves or immediate family.
See template
See template
Massachusetts EmployeeS Withholding Exemption Certificate
PDF template
Tax form for employees to claim withholding exemptions in Massachusetts for state income tax purposes.
See template
See template
Management Evaluation Form
PDF template
A comprehensive form for assessing an employee's professional performance across multiple competency areas.
See template
See template
SEIU UHW West Joint Employer Education Fund Wage Replacement Program ManagerEmployee Agreement Form
PDF template
A document outlining an educational wage replacement program for SEIU-UHW members, allowing employees to reduce work hours for educational pursuits.
See template
See template
Airport Maintenance And Operation Reimbursement Requests
PDF template
Instructions for submitting maintenance and operation expense reimbursement requests for state airports during fiscal years 2016 and 2017.
See template
See template
Manual Claim Form
PDF template
Form for submitting out-of-pocket healthcare expense claims for reimbursement through Flexible Spending Accounts (FSAs) or Health Reimbursement Arrangements (HRAs).
See template
See template
Extended Health Care Claim
PDF template
Insurance claim form for submitting extended healthcare expenses to Manufacturers Life Insurance Company group benefits plan.
See template
See template
Marietta Area Service Committee Expense Form
PDF template
Form for tracking and reporting expenses for service committee members, including travel, supplies, and other costs.
See template
See template
REQUEST TO ISSUE A REFUND
PDF template
A form for requesting a refund for an electronic payment made to Florida Atlantic University
See template
See template
ITP 1 Technology Governance And Procurement Review
PDF template
Defines the technology governance process and outlines requirements for technology procurement review at Marshall University.
See template
See template
Employee Expense Report
PDF template
A form for employees to document and report travel-related expenses, including both personal and company-paid expenditures.
See template
See template
MASA Medical Air Services Association Employee Payroll Deduction Authorization Form
PDF template
Employee authorization form for automatic payroll deductions for MASA membership dues with terms and conditions.
See template
See template
Operative Plasterers And Cement Masons Profit Sharing Annuity Plan Summary Plan Description
PDF template
A summary plan description for a profit sharing annuity plan for plasterers and cement masons, detailing plan provisions as of October 31, 2002.
See template
See template
Budget Form
PDF template
A document for listing and detailing expected expenditures for potential reimbursement.
See template
See template
Application Form For Maternity Benefit
PDF template
Official form for applying for maternity benefits through Social Welfare Services, providing guidance for employees and self-employed individuals
See template
See template
Application Form For Maternity Benefit
PDF template
A comprehensive form for employees and self-employed individuals to apply for maternity leave benefits in Ireland.
See template
See template
Pregnancy Tips And Information For MUSC University Employees
PDF template
Comprehensive guide for MUSC university employees providing information about pregnancy-related benefits, insurance, and leave policies.
See template
See template
Short Term Disability Insurance For Maternity Leave
PDF template
A detailed explanation of short-term disability insurance coverage for maternity leave, including claim filing process and state-specific benefits.
See template
See template
Multnomah Bar Association EnrollmentChange Of StatusWaiver Form
PDF template
A comprehensive form for attorneys to enroll, change, or waive health insurance coverage through the Multnomah Bar Association.
See template
See template
MetroPlusHealth Wellness And Fitness App Reimbursement Program
PDF template
A program offering up to $300 per year in reimbursements for specific wellness and fitness mobile applications for MetroPlusHealth members.
See template
See template
Sharp Health Plan Reimbursement Request Form
PDF template
A form for submitting medical expense reimbursement claims to Sharp Health Plan with detailed instructions and personal information fields.
See template
See template
Direct Deposit Form
PDF template
Official form for School Employees Retirement System of Ohio to establish direct deposit payment method for retirement benefits.
See template
See template
Chronic Illness Benefit Application Form 2024
PDF template
An application form for patients seeking chronic illness benefits through the MultiChoice Medical Aid Scheme for the year 2024.
See template
See template
Dependent Care Claim Form
PDF template
A form for employees to request reimbursement for dependent care expenses through a flexible spending account.
See template
See template
Medical Expense Claim Form
PDF template
A form for employees to claim medical expense reimbursements through their flexible spending account with detailed claim submission instructions.
See template
See template
Form MD 410 457 Loan Application
PDF template
Application for municipal employees to borrow against their retirement account balance with specific loan eligibility and terms.
See template
See template
Miami Dade County Employee Benefits
PDF template
Comprehensive overview of employee benefits package for Miami-Dade County employees, including insurance, retirement, and support services.
See template
See template
CLAIM FORM PART A
PDF template
A comprehensive form for filing health insurance claims, designed to collect detailed patient and insurance information.
See template
See template
Meal Approval Form Policy 1020
PDF template
A form for documenting and approving meal expenses for county business meetings, including attendee details, meal types, and payment information.
See template
See template
MealFood Pre Approval Form
PDF template
A form for pre-approving and documenting business meal expenses at the University by University employees.
See template
See template
Meal Reimbursement Policy
PDF template
Comprehensive policy detailing meal expense reimbursement rules for employees traveling with or without students on college business.
See template
See template
MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
PDF template
A comprehensive medical insurance claim form for submitting healthcare expense reimbursement and insurance details.
See template
See template
Prescription Drug Reimbursement Form
PDF template
A form for submitting prescription medication reimbursement claims through an insurance or benefits program.
See template
See template
ENROLLMENT FORM
PDF template
A comprehensive form for employees to enroll in medical, dental, vision, and life insurance benefits with dependent information and coverage election details.
See template
See template
Medex Subscriber Claim Form
PDF template
A claim submission form for medical services processed by Blue Cross Blue Shield of Massachusetts for Medex subscribers.
See template
See template
H.P.T.R.6 MEDICAL CHARGES REIMBURSEMENT FORM
PDF template
A comprehensive form for employees to claim reimbursement of medical expenses with detailed documentation and verification requirements.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient and treatment details for reimbursement.
See template
See template
Medical Claim Form
PDF template
Insurance claim form for submitting medical expenses and travel-related healthcare claims with multiple payment options.
See template
See template
Member Claim Submission Form
PDF template
A form for submitting medical and vision service claims to an insurance provider for reimbursement.
See template
See template
Medical Claim Form
PDF template
Form for submitting out-of-network health care claims to UnitedHealthcare for reimbursement of eligible medical services.
See template
See template