Forms to be completed by UUP-represented employees only:

All forms are in Adobe Acrobat format.

Benefits Forms

Health Insurance

Eligibility

• Proof of Eligibility for Health Insurance
• Ineligibility for State Health Insurance

Enrollment

• UUP Enrollment Card
• PS-404 NYS Health Insurance Transaction Form
• Pre-Tax Contribution Program Form
• Employee Notice and Fact Sheet (NYS Public Employee Long Term Care Insurance Plan)

Retirement

• TIAA-CREF Investment Guide and Enrollment Form
• NYS Employees' Retirement System Registration Form
• State of New York Retirement Program History Sheet
• Retirement Program Election Form
• State University of New York Optional Retirement Plan
• State Long Term Disability Form (all UUP employees must complete)

Life Insurance

• Surivors' Benefit Program Form
• UUP Group Life Insurance Beneficiary Card

Payroll Forms/Documents

Tax Forms

• Federal Tax Form / W-4
• State Tax Form / IT-2104
• State Exempt Tax Form / IT-2104E

Payroll

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

Other

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