Forms

• 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 Dependent Tax Affidavit Change Form
• 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/Emblem 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 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.

• 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 Data Form (for Departmental use)  Personal and demographic information; required for all new hires and changes in status. (.pdf)
• I-9 for Employment Authorization document that each new employee (both citizen and non-citizen) hired after November 6, 1986 is authorized to work in the United States. 
• State Employees 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. 

• 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. Professional Vacancy Worksheet
• 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.
• Search Process for International Candidates Requiring Permanent Residency
• Statement of Recruitment Efforts

• 2024-2025 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.
• 2024-2025 Faculty/Staff and GATA Deadlines Deadlines for HR transaction processing for Faculty, Staff and GA/TA payrolls.
• 2024-2025 Student Paycheck Dates Payroll calendar for Student Assistant & FCWS.
• 2024-2025 Payroll Deadlines for Timesheets Coded UUP, HRY, CLS-HRYA & CLS-HRY Payroll calendar for Timesheets Coded UUP-HRY, CLS-HRYA & CLS-HRY.
• 2023-2024 Obligation & Payroll Appointment Dates (.PDF) Document outlining obligation and appointment dates for all payrolls
• 2024-2025 Obligation & Payroll Appointment Dates (.PDF) 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. 

• 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.
• 2024 International Tax Witholding 2024 tax withholding guide for International Students and Scholars. 
• Visa Options Common visa categories used to hire international employees. 

• 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
• Paid Family Leave Application To request Paid Family Leave to Care for a family member with a serious health condition
• Paid Family Leave Application To request Paid Family Leave to assist when a family member is called to active military duty or impending active duty abroad
• 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.

• 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. 

2024-2025 Letters

• 2024-2025 GSEU Offer Letter - Clark Fellowship 1st Year
• 2024-2025 GSEU Offer Letter - Clark Fellowship 2nd -5th years
• 2024-2025 GSEU Offer Letter - Stipend & Tuition
• 2024-2025 GSEU Offer Letter - Stipend Only
• 2024-2025 GSEU Offer Letter - Tuition Only

• 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. 

• 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 Classified Service Performance Program/Evaluation
• 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. 
• PEF Performance Program and Evaluation Performance Program and Evaluation document for PEF represented 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 

• 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 NYS Employees Retirement System enrollment form.
• ERS Beneficiary Designation Form NYS Employees Retirement System Beneficiary Form.
• ERS Name Change (RS-5483-I) To notify the Employees' Retirement System of a legal name change. 
• 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), Police & Fire Retirement System (PAFRS) and Teachers Retirement System (TRS) Enrollment Guide to assist employees with requesting to join ERS, PAFRS or (if eligible) TRS via Retirement at Work.
• Voluntary Savings Plan 403(b) Enrollment Guide to assist you with establishing a new SUNY 403(b) voluntary savings plan
• Making Changes to Your 403(b) Voluntary Savings Guide to make 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. 

• 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.

• Accident or Injury Reporting (Part 1 and CS-13) To report an accident or injury on campus property/work-related. 
• Workers Compensation reporting procedure 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.