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A

Account Application Fidelity Investments 403(b) Custodial Account
Affidavit of Domestic Partnership
Affidavit of Eligible Spouse/Child Status
Anthem (NextRx) Prescription Claim Form
Anthem Prescription Order Form
Application/Affidavit to Establish Dependency by Guardianship
Appointed Staff Position Posting Request Form
Authorization Form for Motor Vehicle Records Check (Risk Management)

B

Background Check Consent Form
Beneficiary Designation (Basic Life Insurance)
Beneficiary Designation (PAI)
Beneficiary Designation (Supplemental Life Insurance)

C

Certification of Disabled Dependent Child Eligibility
Certification of Eligibility for Dependent Child Age 19 or Older
Certification of Eligibility for Dependent Child Age 19 or Older - 2009
Certification of Tax-Qualified Dependents - Domestic partnership |
Change Form, Personal Data
Claim form (TSB)
Classification Appeal Form and information in MS Word (Bloomington)
Continuation Form for International Students - Fall 2008
Continuation Form for SAA/Fellowship Students - Fall 2008

D

Dental Claim Form (CIGNA)
Dependent Care Flexible Spending Account Worksheet (TSB)
Direct Deposit Authorization/Termination form (TSB & HRA)

E

Employee Written Authorization for Release of Personnel File(s) (Bloomington)
Enrollment Form (LTD) |
Enrollment Form (Supplemental Life) |
Enrollment/Beneficiary Change (PAI) |
Essential and Marginal Job Functions Worksheet

F

Fee Courtesy 2008-2009 Benefit Enrollment Form |
Fee Courtesy 2007-2008 Benefit Enrollment Form
Fidelity Investments 403(b) Custodial Account, Account Application
Fidelity Investments 457(b) Enrollment Form and Beneficiary Designation
Fidelity Investments IU Retirement Plan Enrollment Form
FMLA Definition of Serious Health Conditions
FMLA Form 1 Leave Notice or Request Approval and Information
FMLA Form 2E Medical Certification for Employee
FMLA Form 2F Medical Certification for Family of Employee
FMLA Form 3 Release/Intent to Return to Work
FMLA Medical Recertification Request
FMLA Time Off Designation/Tracking Sheet

G

Grievance Form for Appointed Service Maintenance Employees (Bloomington)
Grievance Form for Appointed Support Staff (Bloomington and Northwest)
Grievance Form for Non-Union Support and Service Staff
Grievance Form for Professional Staff
Grievance Form for Hourly Employees
Group Long Term Disability Insurance Plan Enrollment Form (LTD)

H

Hourly Employment Application | | RTF version also available (Bloomington)
Hourly Education/Work History Supplement | | RTF version also available (Bloomington)
Hourly HTML online form template for database available upon request (Bloomington)
Hourly Position Posting Request Form(Bloomington)

I

INS Form I-9
   - Form I-9 Instructions
International Dependent Enrollment Form 2008-09 (Student Health Insurance)
Internet Prescription Order Form (Anthem)
IU Health Center Claim Form (Student Health Insurance)
IUHS Tuition Waiver Form |
IU Psychiatric Management (IUPM) Claim Form
IU Retirement Plan Investment Company Change Form
IU Retirement Savings Plan 457(b) Salary Deferral Agreement Form
IUSERP Investment Company Change Form
IU Tax Deferred Annuity Plan Salary Deferral Agreement

J

K

L

Leaves for Military Families Request Form |

M

Medical Claim Form (Anthem)
Medical History Statement For Non-Indiana Residents
Medical History Statement for Residents of Indiana Residents
Mid-Year Salary Adjustment Form for Professional Staff
    Standard form -
    Form to use with 5 or more funding sources -

N

New Employee Information Form (departments only-Bloomington)
Non-Union (Hourly) Employee Grievance Form (Bloomington)

P

Personal Accident Insurance (PAI ) Beneficiary Designation
Personal Profile Form (ED)
Personal Profile Form (PS)
Personal Profile Form (PSA)
Position Description
Prescription Drug Program Direct Member Reimbursement Form (M-Plan)
Pre-Tax Mass Transit Expense Claim form
Professional Employee Grievance Form (Bloomington)
Public Employee's Retirement Fund (PERF) Investment Direction Form

R

Reasonable Accommodation Request and Documentation Form
Retiree Health Care Enrollment Form (under age 65)
Reward Plan Document
Recognition Plan Document

S

SAA/Fellowship Dependent Enrollment Form 2008-09 (Student Health Insurance)
Same-Sex Domestic-Partner Health Plan Benefit Tax Estimation Work Sheet
Separating Employment from IU (Employee Checklist)
Service Maintenance Employment Application | | RTF also available (Bloomington)
Service Maintenance Work History Supplement (Bloomington)
Staff Incident Report (Bloomington)
Supplemental Life Insurance Plan Enrollment Form
Supplemental Group Life Insurance Plan Beneficiary Designation

T

Tax Saver Benefit Direct Deposit Authorization/Termination form
Tax Saver Benefit - see the Benefits Change Connection about making changes to your plan
Telephone Reference Check (Bloomington)
Termination of Domestic Partnership |
TIAA-CREF IU Retirement Plan Enrollment Form
Timesheets
     - PAO and PAU employees
     - Exempt (PAE) Staff PTO Record Card

U

Undergraduate and Graduate Voluntary Enrollment Form (Student Health Insurance)
Unsafe Working Conditions Form for SM, | Word version also available (Bloomington)

V

Visiting Scholars and Dependents Enrollment Form 2008-09 (Student Health Insurance)

W

X

Y

Your 457(b) Enrollment Form (TIAA-CREF Investments)
Your GRSA Enrollment Form (TIAA-CREF)

Z

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