Forms to be completed by Management Confidential (M/C) employees

All forms are in Adobe Acrobat format.

Benefits Forms

Health Insurance

Eligibility

• Ineligibility for State Health Insurance (all non-eligible employees must complete)
• Proof of Eligibility for Health Insurance (memo)

Enrollment

• PS-404 NYS Health Insurance Transaction Form (all benefits eligible employees must complete this form)
• Pre-Tax Contribution Program Form
• Employee Notice and Fact Sheet (NYS Public Employee Long Term Care Insurance Plan)
• State Long Term Disability Form (all M/C employees must complete)

Retirement

• State Employee Retirement System Article 15 Membership Registration Form
• State of New York Retirement Program History Sheet
• Retirement Program Election Form
• State University of New York Optional Retirement Plan
• TIAA-CREF Investment Guide and Enrollment Form
• Surivors' Benefit Program Form (if part time and declining retirement of UUP, M/C and electing optional retirement program)

Payroll Forms/Documents

Tax Forms

• Federal Tax Form / W-4
• State Tax Form / IT-2104
• State Exempt Tax Form / IT-2104E (if filing exempt)

Payroll Forms/Documents

• Direct Deposit Form - State
• Check Diversion Form
• Annual / Hourly Pay Period Schedule
• Understanding Your State Paycheck

Other

• Oath of Office
• Oath of Office - Native American
• Veteran Status Form
• Upstate Annual Calendar