• ADA Disability Accommodation
• Benefits
• Compensation
• Compensation Misc forms
• Criminal Background Check
• Employment
• Faculty and Staff Work Modality Agreements
• Family Status Changes
• Leave Administration

• Leave Administration - misc forms
• Mail Codes
• Position Management
• Records Services
• Retirement Programs
• Selective Service
• Separation / Termination
• Training and Development

ADA Disability Accommodation

• Accommodation Request Form

Benefits

• Benefits Cost Worksheet

• Delta Dental Plan Claim Form

• Medical Claim Form

• Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form

• Superior Vision Plan Claim Form

• UT FLEX Health Care Reimbursement Claim Form

• EOI Form - Life, Short and Long Term Disability

• Accidental Death & Dismemberment Certificate

• Dearborn National Forms (Including Beneficiary Forms)

• Group Term Life Certificate

• Affiliated Postdoctoral Fellow/Graduate Student
  Sponsoring Faculty Form

• Direct Transfer Form

• Incapacitated Child Form

• Tobacco Premium Program Declaration Form

• Qualifying Life Event (QLE)

• COBRA (includes rates and plans available)

• Waiver of Medical Insurance

• Zip Code Exception Form

• UT Flex Dependent Care Reimbursement Claim Form

• UT Flex Letter of Medical Necessity Form

• UT Flex Health Care Reimbursement Claim Form

• Coordination of Benefits

Retirement Programs

• Investment Policy Statement

• Purchase/Change Agreement
  Use to change provider(s) for future retirement contributions

• UT Vesting/Termination Status Form

• Authorization for Reduction for Employee Contribution
  Use for initial ORP election

• Authorization for Reduction for Employee Contribution for Employees Returning to ORP
  Use for ORP election for vested participants returning to employment

• ORP Acknowledgement Form
  Must be signed by all employees who are newly-eligible for ORP

• ORP Declaration of Retirement

• ORP Plan

• Overview of TRS and ORP

• Transfer Verification Form (All plans)
  Use to transfer balances from one provider to another

• TRS Form 28 Election to Participate in Optional Retirement Program and/or Refund
  The TRS 28 must be completed by all participants making their initial ORP election or have an account balance with TRS

Teacher Retirement System - TRS

• TRS Website - Forms

• UTSaver TSA 403(b)

• Tax-Sheltered Annuity Disclosure
  This must be signed before your enrollment into a TSA is effective

• Loan, Hardship and Unforeseeable Emergency Procedures

• Transfer Verification Form
  Use to transfer balances from one provider to another.

• DCP Purchase Agreement
  (for Separations only - Vacation Payout to DCP 457(b) account)

• UTSaver DCP 457(b)

• Loan, Hardship and Unforeseeable Emergency Procedures

• Transfer Verification Form
  Use to transfer balances from one provider to another.

• DCP Catch-Up Provision Agreement - This must be signed if utilizing the Special Catch-Up Provision and must be accompanied by the 457(b) catch-up worksheet.

Direct Payment/Debit Authorization Agreement

Personal Information & Emergency Contact Form

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Compensation

• Position Description Form

• Faculty Salary Election Agreement

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Employment

• Conflicts of Interest Policy Acknowledgement Form

• I-9 List of Acceptable Documents

• Orientation on the Job Checklist

• Acknowledgement of Service without Salary for POI/Volunteer

• Acknowledgement of Service without Salary for Vendor Only (Independent Contractors)

• Promotion/Transfer Policy

• Selective Service Registration Requirement

• DAF - Department Approval Form

• Political Aid, Legislative Influence and Standards of Conduct

• Benefits Eligible Employee Acknowledgment Form
• Non-Benefits Eligible Employee Acknowledgement Form

• English
• Spanish

• Conditional Employment Offer Letter

• Employment Offer Letter

• Interview Questions

• Reference Check Questions

Leave Administration

• Medical Leave Checklist

• Request for Leave of Absence

• Sick Leave Pool Application

• FMLA Physician Certification Form

• FMLA Physician Certification Form for Family Member

• FMLA Adult Child Information Form

• Return to Work Release Form

• Employee Request to Transfer Sick Leave Hours to Sick Leave Pool

• Direct Sick Leave Donation - Recipient

• Direct Sick Leave Donation - Donor

• EEOC GINA Poster

• GINA FAQ

• GINA Fact Sheet
  Download this form with DOL forms below

• WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition

• WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition

• WH-384 Certification of Qualifying Exigency For Military Family Leave

• WH-385 Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave

• Breastfeeding State Laws
• FAQ - Break Time for Nursing Mothers
• Break Time for Nursing Mothers

The Patient Protection and Affordable Care Act (“Affordable Care Act”) amended section 7 of the Fair Labor Standards Act (“FLSA”) to require employers to provide “reasonable break time for an employee to express breast milk for her nursing child for one year after the child’s birth each time such employee has need to express the milk.”

As such, UTSA supports moms in the efforts to both work and continue breastfeeding by providing a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used to express breast milk. See the attached link for more information. http://www.dol.gov/whd/nursingmothers/

For assistance in making arrangements, please contact Leave Administration at HR@utsa.edu

• Families First Leave Application

• Application for Wellness Incentive - Additional Leave

• Wellness Incentive - Additional Leave Fact Sheet

• UTSA Holidays

• Vacation Accrual Rates

Records Services

• Change of Address/Telephone or other Contact information
  An employee who is currently employed at UTSA can change their contact information via the Employee Self Service feature in PeopleSoft.
  
  

  A former employee or retiree who wishes to make changes to their contact information must contact HR by email HR@utsa.edu or by phone 210-458-7210.
  

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Separation / Termination

• Acceptance of Resignation Letter (Template)

• Employee Separation Process - Administrator Guidelines
• Employee Separation Process - Employee Guidelines
  
  

• Separation Processing Checklist

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Training and Development

• Class Evaluation Form

• Individual Sign-in Sheet

• Sign-in Sheet

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Mail Codes

• Mail Codes sorted by Department

• Mail Codes sorted by Mail Code

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