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Benefits | Insurance | General | Payroll

BENEFITS
Accidental Death & Dismemberment Insurance
Application UW1245
Application - Continuation UW1249
Application - Pilot HRIS B1247
Application - History HRIS B1248
Certificate
Fact Sheet UWS B1246
Dental Insurance
Application OSER/UW Application
Application - Continuation UWS8
Plan Summary
HMO Handbook DC DC-83445-7, -9999
HMO Provider Directory
PPO Handbook DB DC-83445-8, -18
PPO Provider Directory
Supplemental Handbook DC DC-83445-9, -19
Employee Reimbursement Accounts Program
Application
Automastic Premium Conversion Waiver/Revocation of Waiver
Booklet
Change Form
Group Health Insurance
Application - Classified, Unclassified ET-2301
Application - Graduate Assistants ET-2302
Application for Continuation ET-2311
Booklet "It’s Your Choice" for Classified and Unclassified ET-2107
Booklet "It’s Your Choice" for Graduates Assistants ET-2127
Rates for Less Than Half-Time Employees (Classified and Unclassified) UW1333
Group Life Insurance
Application - Continuation ET-2154
Application - Conversion ET-2306
Application - Enrollment/Change ET-2304
Application - Evidence of Insurability ET-2305
Beneficiary Designation Form ET-2320
Booklet ET-2101
Premium Waiver Request ET-5306
Income Continuation Insurance
Application ET-2307
Application - Evidence of Insurability ET-2308
Brochure ET-2106
Individual and Family Group Life Insurance
Application 03-30539
Application - Conversion 03-30573
Application - Evidence of Insurability 03-30538
Beneficiary Designation Form F53232
Brochure F. 59114
Conversion Brochure F4638-11
Certificate 03-30541
Dental & Excess Medical (EPIC) a/k/a Major Medical
Application E11444
Application - Continuation E11472-0011
Beneficiary Designation Form
Brochure E11549
Tax Sheltered Annuities
Question and Answer Guide UWS32
Salary Reduction Agreement UWS31 (Fillable)
Salary Reduction Agreement UWS31 (Complete and Print)
University Insurance Association, Life Insurance
Application - Continuation UW1443-1
Beneficiary Designation Form F. 59786
Certificate 03-30564
UW Employees Inc. Life Insurance
Application GA-1314
Application - Evidence of Insurability GA-1129
Beneficiary Designation Form GA-562
Brochure GA-1117
Certificate UW/GIC/05
Spectera Vision Insurance
Application - Continuation
Worker's Compensation
Employer's First Report of Injury or Illness WKC-12
Supervisor's Accident Analysis and Prevention Report WKC-SUP
Worker's Compensation Timesheet UW1059
General
Domestic Partnership - Affidavit UWS50
Domestic Partnership - Termination Affidavit UWS51
Notice of Benefit Eligibility UW1030
Rehired Annuitant Election ET-2319
INSURANCE
Insurance
Insurance Prepayment/Reinstatement Request UW1540
GENERAL
Employee Benefits Sick Leave Conversion at Layoff UWS40
Rehired Annuitant Report ET-2319
PAYROLL FORMS
Employee Information
Direct Deposit Authorization UW1032
Employee Information UW1035 (fillable)
Home Address Report UW1264
Senority Information UW1058
Payroll 
Checksheet (Blank) UW1011
Check Stop Payment UW1368
Missed Punches (Kronos) UW1537
Paycheck Correction UW1383
Report Request UW1263
Salary Advance Request UW1275
Special Award Payment UW1276
Missed Payroll Request UW1274
Temporary Payroll Number Request UW1051
Taxes
W-4 Form Employee’s Withholding Allowance Certificate UW1389
International Tax Packet UW1469