Forms

Telecommuting Application Electronic Process:

To simplify this process, for employees in non-academic units, please direct your application to your Director or equivalent and carbon copy your supervisor,  who is already aware of your remote assignment.  After review and comment (if applicable), the Director will submit the application to Human Resources. For academic areas,  please direct your application to your Chair and carbon copy your supervisor if applicable.  Chairs should route their approval to the appropriate designee in the Dean's office.  The Dean's office approval will then route to Human Resources.

https://my.binghamton.edu/workflow/hr_eforms/telecommuting_pilot_application

Telecommuting Application Paper Process:

The Telecommuting Pilot Program Application does not apply to faculty since all faculty are teaching remotely. Professional and Classified staff should submit their completed form to their department Chair/Director, who should then submit to the next level of administration. Completed forms should be sent to Sara DeClemente-Hammoud in Human Resources at declemen@binghamton.edu.

TELECOMMUTING PILOT PROGRAM APPLICATION 

• Benefits (Health Insurance, Dental, Vision, Tuition Assistance, etc.)
  • Address Change
  • CSEA Dental Claim  For CSEA represented staff to submit dental expenses to the union's employee benefit fund
  • CSEA Full-Time Student Verification  To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by the CSEA Benefit Fund
  • CSEA Prescription Co-Pay Reimbursement Drug Claim form for CSEA benefits fund covered prescription drug co-pay expenses
  • Davis Vision Student Verification Form To verify that a dependent child age 19 or over is a full-time student for dental and vision benefits provided by UUP, MC, PBA-NYS, NYSCOPBA and PEF dental benefits.
  • Dependent Care Advantage Account Reimbursement (Flexible Spending) To request reimbursement for dependent care related expenses from your existing flexible spending account. Daycare or elder care expenses for example.
  • Domestic Partner Application for Benefits (PS-425)  Affidavit of domestic partnership and financial interdependence. For employees in the following bargaining units: CSEA, UUP, PEF, GSEU, PBA, M/C, NYSCOPBA.
  • Domestic Partner Termination of Partnership (PS-425.4) To request a termination of a domestic partnership.
  • Empire Plan Non-Participating Claim To request reimbursement for expenses from a non-participating health care provider.
  • Empire Plan Pharmacy Reimbursement Claim To request reimbursement for prescription drug expenses when paid out of pocket.
  • Empire Plan Pharmacy Mail Order Form To request mail order of prescription drugs.
  • EyeMed Full-Time Student Verification To confirm full-time student status for dependents age 19-24 when using the EyeMed vision plan. For M/C, PEF, Council 82 and NYSCOPBA only.
  • GA/TA Employment & Benefits Checklist  For new, returning or rehired graduate and teaching assistants.  
  • GHI Dental Claim To request reimbursement for dental claims. For GSEU, M/C, PEF, Council 82 and NYSCOPBA only.
  • GHI Full-Time Student Verification  To confirm full-time student status for dependents age 19-24. M/C, PEF, Council 82 and NYSCOPBA only.
  • GSEU Health Insurance Transaction Form (PS-404G)  For Graduate Student Employee Union health plan enrollment or changes.
  • GSEU Health Insurance Enrollment Instructions for PS-404G Instructions for completing the form PS-404G GSEU Health Insurance Enrollment Form.
  • GSEU Health Insurance Summer Continuation Notice GSEU Health Insurance Summer Continuation Notice.
  • Health Care Spending Account Reimbursement (Flexible Spending) To request reimbursement for health care related expenses from your existing flexible spending account.
  • Health Insurance Transaction Form (PS-404) Health insurance enrollment and changes for faculty and staff. 
  • Health Insurance Opt Out Attestation (PS-409) Form to opt out of health insurance coverage. 
  • State University Tuition Waiver Program Application and Instructions Request reimbursement for all or part of an employee's tuition cost.
  • UUP Benefit Fund Address Change For employees represented by UUP.
  • UUP Benefit Trust Fund Enrollment Dental and vision enrollment for United University Professions (UUP) represented employees. 
  • UUP Benefit Trust Fund Marital Status or Dependent Change To notify UUP Benefit Trust Fund of marital status or dependent changes for dental and vision benefits.
  • UUP Delta Dental Claim  For UUP represented faculty/staff to submit dental claims.
  • UUP Full-Time Student Verification For dependents of UUP represented faculty/staff between ages 19 and 25.
  • UUP Group Life Beneficiary Designation For all faculty/staff represented by UUP; First UNUM Life Insurance Co.
  • UUP and MC Unclassified Long Term Disability Application For MC unclassified and UUP professionals.
• Employment
  • Alternate Work Options See attached policy
  • Email Information for New Faculty/Staff Information on how to access your new email address at Binghamton University.
  • Employee Information Form Personal and demographic information; required for all new hires and changes in status.
  • I-9 Employment Eligibility To document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. 
  • State Employee Statement in Lieu of Oath Certifies that a State employee has read and understands the NYS Public Officer's Law. Required for all new faculty/staff and graduate/teaching assistants and those changing official budget titles.
  • PA-81 Internal Application for Promotion For classified service, non-competitive, labor class promotion. Employee's status must be permanent or contingent permanent. 
  • Phased Retirement Request For UUP and Management Confidential staff requesting to work less than full-time as near retirement. 
  • Prior Service Credit Request for Faculty Prior service request form for faculty hired in a tenure track position. 
  • Professional Employee Promotion/Reclassification/Salary Increase Request For non-teaching, UUP represented, professional staff. Requests accepted during appropriate window. 
  • Faculty/Staff Handbook Receipt Acknowledgment of receipt of the Faculty and Staff Handbook information. 
• Hiring and Recruitment
  • ADA Cover Memo Americans with Disabilities Act Memo. 
  • ADA Position Analysis Americans with Disabilities Act position analysis. 
  • ADA Position Description Americans with Disabilities Act position description. 
  • Office of Diversity, Equity & Inclusion (DEI) Hiring Guides and Resources For search committee use. Submit to Office of Diversity, Equity & Inclusion for approval.
  • Binghamton University Education History Addendum Attach as needed to the employment application form.
  • Binghamton University Employment Application Application for employment.
  • Binghamton University Employment History Addendum Attach as needed to the employment application form.
  • Professional Vacancy Worksheet To assist Human Resources with the posting of a professional vacancy.
  • Recruitment Links For a list of various sources to advertise with for a position you are hiring for.
  • Verification of Candidate Credentials For professional vacancy search committee use.
• HR Masters and Coordinators
  • 2020-2021 Student Assistant & Federal College Work Study HR Payroll Processing Deadlines Deadlines for HR payroll & transaction processing for the Student Assistant and Federal College Work Study payrolls.
  • 2020-2021 Faculty/Staff & GA/TA HR Transaction Processing Deadlines Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls
  • 2020-2021 Student Paycheck Dates Payroll calendar for Student Assistant & FCWS.
  • 2020-2021 Payroll Deadlines for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY Payroll calendar for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY.
  • 2020-2021 Obligation & Payroll Appointment Dates Document outlining obigation and appointment dates for all payrolls.
  • 2021-2022 Obligation & Payroll Appointment Dates Document outlining obligation and appointment dates for all payrolls.
  • Agreement to Protect Confidential Information Agreement to protect confidential information. 
  • Appointing to Faculty Titles Instructions on how to appoint to faculty titles. 
  • Dual Employment Form (AC-1588) Form to be completed by employees working for multiple state agencies.
  • Petition for GA/TA Dual Employment Form Form to be completed by GA/TA employees to take on additional work.
  • Extra Service Checklist Checklist of forms to be completed to process extra service.
  • Extra Service Payroll Voucher (AC-873) Time record to be completed for Dual Employment Extra Service. 
  • Extra Service Policy Extra service policy. 
  • Extra Service Request Form Form to be completed by departments paying for on campus extra service for state employees.
  • UP-8 For UUP employees to request approval for extra service at another state agency. 
  • UP-6 For Management Confidential employees to request approval for extra service at another state agency. 
  • HR Forms "Which Form Do I Use"  Instructions for which HR Form to use. 
  • Organization Request Form Request form for creating/updating organizations. 
  • Position Request Form for State Payrolls Position request form for all payrolls. 
• Immigration Services
  • Extend H-1B Questionnaire for department Questionnaire for extension of H-1B for department completion. 
  • Extend H-1B Questionnaire for employee Questionnaire for extension of H-1B for employee completion. 
  • Immigration Process for department Flow chart of immigration process for departments.
  • Initial H-1B Questionnaire for department Questionnaire for initial H-1B for department completion. 
  • Initial H-1B Questionnaire for employee Questionnaire for initial H-1B for employee completion.
  • 2021 Tax Withholding Guide for International Students and Scholars 2021 tax withholding guide for International Students and Scholars. 
  • Visa Options Common visa categories used to hire international employees. 
• Leaves
  • Confidential Medical Statement To be completed by a health care provider.
  • Confidential Medical Statement (Work Related Injury) To be completed by a health care provider for a work-related injury.
  • Confidential Medical Statement (CSEA only) To be completed by a health care provider for non work-related injuries (CSEA only).
  • Confidential Medical Statement (Cancer Screening) To be completed by a health care provider. 
  • FMLA - Employee's Serious Health Condition Family and Medical Leave Act request form. 
  • FMLA - Family Member's Serious Health Condition  Family and Medical Leave Act request form. 
  • FMLA - FMLA Illness of Covered Service Member for Military Family Leave Family and Medical Leave Act request form. 
  • FMLA - FMLA Qualifying Exigency for Military Family Leave Family and Medical Leave Act request form.
  • Leave Donation (for all bargaining units) To donate vacation leave to cover an "eligible" employee's sick leave. 
  • Paid Family Leave Application To request Paid Family Leave to bond with a newborn, a newly adopted or fostered child
  • Tenure Clock Stop Request Form Request form to stop tenure clock. 
  • Title F Leave Request for Faculty See Faculty/Staff handbook section IV.B.2. Leave of Absence (Title F Leave). 
  • Title F Leave Request for Professionals For UUP represented professional staff.
• Miscellaneous
  • Child Protection Processing Guidelines Child Protection Processing Guidelines. 
  • Volunteer Information Collection Form and Agreement Volunteer Information Collection Form and Agreement. 
  • HR Data Report Request Online HR data report request for campus use of Binghamton University HR Coordinators and HR Masters only. 
  • Workplace Violence Policy Workplace violence policy. 
• Payroll
  • Direct Deposit (AC-2722) For new, changes or deletions of direct deposit of your payroll into your bank account(s). 
  • Direct Deposit Reactivate To reactive an existing direct deposit which may have lapsed. May NOT be used to start a new direct deposit allocation. Direct Deposit Reactivate
  • Federal Tax Form W-4  To withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.
  • Honoraria Payment FAQ's Frequently asked questions regarding honoraria payments. 
  • Honoraria Payment Policy Policy regarding honoraria payments to faculty and professional staff.
  • New York State Certificate of Nonresidence and Allocation of Withholding Tax (IT-2104.1)  New York State, City of New York, and City of Yonkers Certificate of Nonresidence and Allocation of Withholding Tax. 
  • New York State Tax Certificate of Exemption (IT-2104-E) To claim exemption from withholding for New York State personal income tax (and New York City and Yonkers personal income tax, if applicable).
  • New York State Tax Form (IT-2104) To withhold the correct New York State income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes.
  • SUNY Charitable Giving Campaign Payroll Deduction You can give to the State University of New York campus of your choice through the SUNY Charitable Giving Campaign.
  • Treasury Direct Deposit Form Treasury Direct Deposit Form ONLY.
  • NYS Payroll Online Instructions Instructions on how to navigate the NYS Payroll Online system
  • Unclaimed Check Policy Unclaimed check policy. 
  • W2 Reissue Request Form to request a W-2. 
• Performance Management
  • Alternate Work Location Assignment Request Form Request form for an Alternative Work Location Assignment 
  • Classified Service Performance Program/Evaluation Performance program and evaluations for all classified service staff 
  • Professional Employee Evaluation For non-teaching, UUP represented professional staff. Professional Employee Evaluation
  • Professional Employee Performance Program For non-teaching, UUP represented professional staff. Professional Employee Performance Program
  • Online Professional Employee Performance Program For non-teaching, UUP represented professional staff 
  • Professional Employee Self-Evaluation For non-teaching, UUP represented professional staff.
  • Performance Program Addendum For non-teaching, UUP represented professional staff. Used to add something to the performance program that is already in place. 
• Retiree Services (Forms for Retired Employees)
  • Binghamton University Service Preference Checklist for Binghamton University retirees 
  • Retire Contact Information Form Contact information form for Binghamton University retirees' 
  • Retiree Survey Survey for Binghamton University retirees' 
  • Retiree Volunteer Form Form for Binghamton University retiree volunteers 
• Retirement (Forms for Current Employees)
  • ERS Address Change (RS-5512) Change of address form for active Employees' Retirement System members only (not retirees). 
  • ERS Loan Application Tiers 1 & 2 (RS-5025) For Tier 1 and Tier 2 Employees' Retirement System members to request a loan. 
  • ERS Loan Application Tiers 3 & 4 (RS-5025-A) For Tier 3 and Tier 4 Employees' Retirement System members to request a loan. 
  • ERS Membership Application & ERS Beneficiary Designation Form Employees' Retirement System membership registration form Beneficiary Form Link ERS Application. 
  • ERS Name Change (RS-5483-I) To notify the Employees' Retirement System of a legal name change. 
  • Retirement@Work Participant Quick Reference Guide Access to Retirement at Work online registration system and initial retirement plan declination/enrollment or making changes to your voluntary savings plan contributions
  • Choosing an Effective Date Guide Guide to assist you with choosing the effective date for online change requests to 403(b) contributions via Retirement at Work.
  • SUNY Optional Retirement Program (ORP) Enrollment Guide to assist eligible employees with requesting to join the SUNY ORP retirement plan via Retirement at Work.
  • NYS Employees Retirement System (ERS) & Teachers Retirement System (TRS) Enrollment Guide to assist employees with requesting to join ERS or (if eligible) TRS via Retirement at Work.
  • Voluntary Savings Plan Enrollment & Making Account Changes Guide to assist you with establishing a new SUNY 403(b) voluntary savings plan or making employee contribution changes to an existing SUNY 403(b) account.
  • Retirement System Option for Student Employees Form to acknowledge retirement system options for student employees. 
  • SUNY Voluntary Savings Plans Comparison Plan comparison of the Voluntary Savings Plan (403b) vs. NYS Deferred Compensation Plan (457).
  • Police & Fire Retirement System Membership Application NYS University Police Retirement System enrollment form.
  • TRS Beneficiary Designation (NET-11.4) Designation of beneficiary for active Teachers' Retirement System members only (not retirees). 
  • TRS Loan Application (LON-26) For Teachers' Retirement System members to request a loan. 
  • TRS Membership Application Teachers' Retirement System membership registration form. 
  • TRS Member Name/Address Change To notify the Teachers' Retirement System of a legal name/address change. 
• Time and Attendance
  • Accruals by Bargaining Unit Accrual rates for vacation/annual, sick and personal leave accruals. 
  • Classified Annual Time Sheet (CLS-ANN) For classified service staff with an annual pay basis.
  • Classified Hourly with Attendance Rules Time Sheet (CLS-HRYA) For classified service staff with an hourly pay basis and attendance rules coverage. 
  • Classified Hourly without Attendance Rules Time Sheet (CLS-HRY) For classified service staff with an hourly pay basis and NO attendance rules coverage. 
  • Faculty Time & Attendance Log-in to SUNY.edu for Time & Attendance for all Faculty. 
  • Federal College Work Study (28023) Time Sheet Log-in to SUNY.edu for Time & Attendance for all federal college work-study employees.
  • Graduate and Teaching Assistant Time Sheet Time Sheet for graduate and teaching assistants on the 28029 payroll only. 
  • Management Confidential (M/C) Time & Attendance Log-in to SUNY.edu for Time & Attendance for all Management/Confidential staff. 
  • Professional Annual and College Year Staff Time & Attendance Log-in to SUNY.edu for Time & Attendance for UUP represented professional staff with an Annual or College Year obligation. 
  • Professional Non-Exempt Time & Attendance Time Record for Professional Non-Exempt employees. 
  • Professional Hourly Staff Time Sheet (UUP-HRY) For UUP represented professional staff with an hourly pay basis. 
  • Student Assistant (28021) Time Sheet Log-in to SUNY.edu for Time & Attendance for all student assistant employees.
• Workers Compensation, Accidents, Accommodations
  • Accident or Injury Reporting (Part 1 and CS-13) To report an accident or injury on campus property/work-related. 
  • Workers' Compensation Reporting Procedures A document outlining the necessary steps for reporting an accident at work. 
  • Confidential Medical Statement for Work-Related Disability A document to report a work related disability. 
  • Estimated Capabilities Form A document to report estimated capabilities. 
  • Reasonable Accommodation Information on Reasonable Accommodation. 
  • Reasonable Accommodation Form Request for Reasonable Accommodation.