• Work Force Planning
• Benefits
• Education Benefits
• Recruitment and Staffing
• Compensation Management

• Payroll
• Employee Records
• Employee Relations
• Compliance & Immigration Services
• Workers' Compensation
• Links

• Request for Exemption from Hiring Freeze

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• U.Va.Health Plan

• Enrollment Application

• Medical Claim Form

• Pharmacy Claim Form

• Dental Claim Form

• Mental Health Claim Form

• COBRA Eligibility and Enrollment

• Out of Area (OOA) Enrollment Form

• Authorization to Disclose Protected Health Information

• Authorization to Disclose Protected Health Information to Family Member or Other Person

• Vision Insurance

• Davis Vision Plan Explanation and Rates

• Davis Vision Plan Summary of Benefits

• Davis Vision Plan Enrollment Form

• Davis Vision Claim Form

• MAMSI and Optimum Choice Health Plans

• Housestaff Optimum Choice HMO Enrollment Application

• Housestaff MAMSI PPO Enrollment Application

• Flexible Spending Accounts

• Enrollment Application

• Claim Form

• 2007 FSA Claim Form - This form is to be used for claims incurred prior to 12/31/2007.

• Grace Period Claim Form - to be used for claims incurred between 1/1/08 - 3/15/08 when requesting payment from CY2007 balance.

• FSA Status Change Form

• Life and AD&D Insurance Forms

• Housestaff - Guardian Life Insurance Enrollment Form

• Medical Center - Prudential Life Insurance Enrollment Form

• Medical Center - Prudential Life Insurance Certificate of Coverage

• Medical Center - Prudential Life Insurance Beneficiary Designation

• Medical Center - Prudential Life Insurance Evidence of Insurability - Long Form

• Medical Center - Prudential Life Insurance Evidence of Insurability - Short Form

• VRS - Minnesota Life Optional Life Enrollment Form

• VRS - Minnesota Life Optional Life Change Form

• VRS - Minnesota Life Beneficiary Change Form

• VRS - Minnesota Life Evidence of Insurability

• VRS - Minnesota Life Conversion Form

• The Standard Life Enrollment/Change form

• The Standard Medical Statement

• The Standard Conversion Form

• Faculty AD&D Insurance Application

• Faculty AD&D Beneficiary Form

• Medical Leave

• Family Medical Leave (FMLA) Form

• VRS Retirement Forms

• Service Retirement Application

• Disability Retirement Application

• Refund Request

• Beneficiary Change Form

• Member Information Change Form

• Faculty Retirement Plan (FRP), Medical Center Retirement Plan (MCRP), Tax Deferred Savings Plan (TDSP) and Cash Match Forms

• Tax Deferred Savings Program Authorization Form for Salaried Employees (formerly "Salary Reduction Agreement")

• Tax Deferred Savings Program Authorization Form for Wage Employees (formerly "Wage Reduction Agreement")

• Fidelity 401(a) Application (FRP, MCRP and Cash Match)

• Fidelity 403(b) Application

• Fidelity 403(b) Investment Options

• Fidelity 401(a) Investment Options

• Fidelity 403(b) Fund Performance (03/31/2008)

• Fidelity 401(a) Fund Performance (09/30/2007)

• TIAA-CREF 401(a) Application (FRP and Cash Match)

• TIAA-CREF 401(a) Application (MCRP)

• TIAA-CREF 403(b) Application

• Vanguard 403(b) Application

• Vanguard 401(a) Application (FRP and Cash Match)

• Vanguard Fund Performance (12/31/2007)

• Medex Forms

• Medex Travel Assistance Enrollment

UHR Education Benefits

• Tuition Reimbursement

• Tuition Assistance

• Employee Request for Tuition Waiver

• Enrollment Form (For classes after July 1, 2008)

UHR Recruitment and Staffing

• Dual Employment Form

• Addendum to Application for Apprenticeship

• Reassignment Request Form

• User Security Form (Legacy OPAS)

• Selective Service Compliance Form

• Voluntary Certification of Disability and/or Veteran's Status Form

UHR Compensation Management

• Earnings Element Request Form

• Employee Work Profile (Work Description)

• Pay Action Request Form

• Position Action Form

• Position Action Appeal Form

• Recognition Award Request Form

UHR Payroll

• Direct Deposit Authorization Form

• VA Income Tax Withholding (VA-4)

• Federal Income Tax Withholding (W-4)

• Earned Income Credit Advance Payment Certificate (W-5)

• Moving Expense Agreement

• Moving Expense Summary

• W-2 Reissue Form

• Generic Time Management Form

• Time Management Form with Instructions

UHR Employee Records

• Faculty Salaried Personnel Hire Form

• Faculty Wage/Student Personnel Hire Form

• Address Change

• Faculty Personnel Action Form

• Removal of Access Privileges

• Leave Forms

• Ill Health Certification

• Leave Sharing Donor Application

• Leave Sharing Recipient Application

• Request for Overtime Leave Payment

• Acknowledgement of Extraordinary Contribution Form

• Departmental Orientation Checklist

• Employee Work Profile (EWP)

• Family Medical Leave (FMLA) Form

• Notice of Improvement Needed/Substandard Performance Form

• Outstanding Contributors Award Nomination Form

• Probationary Progress Review

• Written Notice (Save with 7.0+)

• Immigration Packets for Hiring International Employees

• Conrad State 30 Waiver Packet

• H-1B Packet - (Form, sample letter, etc)

• Non-Immigrant & Imigrant Petition Fee Schedule (2008)

• O-1 Packet - (Form, sample letter, etc)

• Permanent Residence Packet (Outstanding Category)

• Permanent Residence Packet (PERM) - Traditional

• PERM Questionaire (for School or Department)

• Permanent Residence Packet (PERM) - Teaching Faculty Hired in Last 16 Months

• Teaching Faculty Posting Notice Template (for School or Department)

• Permanent Residence Packet (RN and Professional Nurses)

• RN Posting Notice Template (for Medical Center)

• Education and Experience Worksheet (for Employee) - For all Permanent Residence Packets except Outstanding Researcher Category

• TN Visa Packet - Port of Entry

• TN Visa Packet - Change/Extend Status

• Taxation and Payment to Foreign Nationals

• Application for IRS Individual Taxpayer ID

• Approval for Honoraria

• Exemption from Withholding for Nonresident Alien

• Nonresident Alien Visa Table

• Required Documentation for Travel or Honoraria Payments

• Tax Form Web Sites

• I-9 Form

• Technical Qualifications Questionnaire for STEM Employees

• Workers' Compensation Attending Physician Panel For University Academic Division Faculty and Staff