Human Resources

University of Massachusetts > Human Resources > Forms - HR

Address/Name Change Form

• Address/Personal Data Change Form (PDF)

Dental Insurance Forms

• Dental Enrollment/Change Form (PDF)
• Dental Claim Submission (PDF) - For reimbursement of dental charges
• Dental Student Certification Form (PDF)

Employment Forms

• Personal Data Questionnaire (PDF)
• I-9 Form (PDF) - Employment Eligibility Verification Form
• Computer Awareness & Data Security Statement (PDF)
• Shrewsbury Site Parking Form 

Flexible Spending Account

• Flexible Benefit Plan Claim Form (PDF)
• Flexible Benefit Plan Enrollment and Change Form
• GIC Flexible Spending Account Program

Health Insurance Forms

• GIC Enrollment and Change Form (PDF) - Form 1
• GIC Insurance Data Form (PDF) - IDF Form
• GIC Dependent Age 19 and Over - Continued Coverage Form (PDF)

Leave Forms

• Family Medical Leave Act Request (PDF)

Miscellaneous Forms

• Tuition Waiver Form (PDF)
• Telecommuting
• MBTA Pass Enrollment/Change Form (PDF)

Optional Retirement Savings

• 403b (PDF) - Salary Reduction Agreement

Payroll Forms

• W-4 (PDF) - Federal Withholding Form
• M-4 (PDF) - Massachusetts Withholding Form
• Direct Deposit (PDF) - Payroll Direct Deposit Form
• Long Term Adjustment (PDF) - Funding Changes (Business Managers Use Only)
• Exception Employee Attendance Correction Form (PDF)
• Work Schedule Form (PDF) 

Retirement Forms

• New Member Enrollment Form (PDF) - State Retirement System (SERS)
• Withdrawal of Accumulated Deductions Request Form (PDF) - State Retirement System (SERS)
• Optional Retirement Program Forms (ORP)

Worker's Compensation

• Notice of Injury Form (PDF)
• Employer's First Report of Injury or Fatality - Form 101 (PDF)

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