UHR Web Content - Forms

• Health Forms


• Flexible Spending Account Forms


• Leave Forms


• Life & Disability Forms


• Long Term Care Forms


• State Retirement & Pension Forms


• Supplemental Retirement Forms


• Tuition Remission Forms


• Miscellaneous Benefits Forms

Acting Capacity Form

Contingent I Contract

Contingent II Contract

Nonexempt Employment Application (online, Word doc, PDF)

Overload Authorization/Non-Teaching Assignment

Overload Authorization/Teaching Assignment

Position Description Form

Requisition Form

Student Wage Exemption Form

I-9 Form

Health Forms

July 2007 to June 2008 Regular Status Health Benefits Enrollment Form

July 2008 to June 2009 Regular Status Health Benefits Enrollment Form

July 2007 to June 2008 Contingent II/COBRA Health Benefits Enrollment Form

July 2008 to June 2009 Contingent II/COBRA Health Benefits Enrollment Form

July 2007 to June 2008 Retiree Health Benefits Enrollment Form

July 2008 to June 2009 Retiree Health Benefits Enrollment Form

Tax Affidavit for Dependent Children Effective July 1, 2008

Care First Form - for nonparticipating provider's claims

Change of Address Form

Notification of Termination for Benefits Form

Prescription Forms (mail order, etc.)

Student Verification Form

Tax Affidavit for Dependent Children

The Health Insurance Portability & Accountability Act

Disabled Dependent Certification Form

Flexible Spending Account Forms

Dependent Care Account Claim Form

Flexible Spending Account Direct Deposit Form

Health Care Account Claim Form

Leave Forms

Advanced Sick Leave (Bargaining)

Advanced Sick Leave (Non-Bargaining & Sworn Police)

Extended Sick Leave

Family & Medical Leave Form (FMLA)

Military Administrative Leave Form

Leave without Pay Form (LWOP)

Life & Disability Forms

Standard Life Beneficiary Form

Standard Life Medical History Statement Forms

UNUM Life & LTD Evidence of Insurability

UNUM Term Life & LTD Enrollment

UNUM Life Beneficiary Form

UNUM Life Coverage Highlights

UNUM LTD Coverage Highlights

Long Term Care Forms

Forms not available at this time. Update in progress.

State Retirement & Pension Forms

Active Member Forms

Retiree Forms

Supplemental Retirement Forms

403b Fidelity (SRA) Payroll Deduction Form

403b TIAA CREF (SRA) Payroll Deduction Form

457b Fidelity (SRA) Payroll Deduction Form

457b TIAA CREF (SRA) Payroll Deduction Form

Maryland Supplemental Retirement Plans 401k/457b/403b Change Form

Tuition Remission Forms

Tuition Remission - UMCP Only (TR-ELF)

Tuition Remission - Other USM Institutions

Miscellaneous Benefits Forms

Application for Social Security Card

Contract Appointment Renewal

Employee Designee Information Form

Mailing Label Request Form

Instructions for Employees with Prior State Service

The 3 D's List Request

PHR Data Request Form

PHR Listserv List Request Form

UM Data Warehouse Account Request Form

PHR Data Warehouse Client Training Registration

PHR/WOW Training Registration

Advanced Sick Leave (Bargaining)

Advanced Sick Leave (Non-Bargaining & Sworn Police)

Disciplinary Suspension Form

Extended Sick Leave

Request Family & Medical Leave Form (FMLA)

DOL Certification of Health Care Provider

Grievance Form

Immediate Termination of Access Form - Involuntary Separation

Leave without Pay Form (LWOP)

Performance Review & Development (PRD):

Officer, Dean, Academic Administrator (PDF, Word doc)

Administrative, Managerial (PDF, Word doc)

Employee (PDF, Word doc)