Human Resources

University of Massachusetts > Human Resources > Forms - HR

Employment Forms

• Personal Data Questionnaire (PDF)
• I-9 Form (PDF) - Employment Eligibility Verification Form
• Address/Personal Data Change Form (PDF)
• Computer Awareness & Data Security Statement (PDF)

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)

Leave Forms

• Family Medical Leave Act Request (PDF)
• (SERV) State Employees Responding as Volunteers Program (PDF)

Insurance Forms

• GIC Enrollment and Change Form (PDF) - Form 1
• GIC Insurance Data Form (PDF) - IDF Form
• Dental Enrollment/Change Form (PDF)
• Dental Claim Submission (PDF) - For reimbursement of dental charges
• Dependent Age 19 and Over - Continued Coverage 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)

Optional Retirement Savings

• 403b (PDF) - Salary Reduction Agreement

Pre-Tax Savings Forms

• DCAP Claim Form (PDF) - Dependent Care Expenses Reimbursement Claim Form
• HCSA Claim Form (PDF) - Health Care Expenses Reimbursement Claim Form
• HCSA/DCAP Enrollment/Change Form (PDF)
• SHPS Debit Card Brochure (PDF)

Miscellaneous Forms

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

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