HR & Payroll / Forms & Policies

Employee/Payroll Forms Top of page

Blood Donation Leave Policy
Direct Deposit Enrollment Form
Dual Employment Form
Educational Assistance Packet
Educational Assistance Policy
Employee Assignment Form
Employee Information Change Form
Exit Survey
FMLA Employee Information on the Family Medical Leave Act
Hourly Voucher
Institutional Conflict of Interest Policy
Leave Donation Program Form
Military Leave Policy and Request Form
Outside Activity Policy
Outside Activity Form
Part Time Work Schedule
Performance Evaluation & Development Form
Performance Evaluation Employee Self Analysis Form
Professional Liability Questionnaire
Promotion Request Worksheet
Request for a Replacement Check
RFMH Salary Plan Document
Request for Retirement Service Credit
SRA Salary Reduction Agreement
SRA Custodial Agreement and Verification forms
TIAA Designation of Beneficiary
Veteran Designation Form

Tax Forms Top of page

2017 W-4 Employee's Withholding Allowance Certificate
2017 IT-2104 NYS Withholding Allowance Certificate
2017 IT-2104E NYS Certificate of Exemption from Withholding
Request for Duplicate W-2
Online W2 Enrollment
BDS Link

Flex Plan Forms Top of page

Dependent Care W-10 Form
Instructions for online access to your account
DAC online
2017 Health Flex & Dependent Care Enrollment Form
2017 Transportation & Parking Enrollment Form
2017 Healthflex Reimbursement Form
2017 Dependent Care Reimbursement Form
2017 Health & Dependent Care Qualifying Event Change Form
2016 Health Flex Reimbursement Form
2016 Dependent Care Reimbursement Form
FAQ's for Flexible Spending Accounts
Employee User Guide for the Wealthcare Admin Portal
Mobile App Information
Flex Spending Account Store Flyer
Healthcare & Dependent Care Handbook
Flex Plan Check Replacement Request
Debit Card Replacement Request
Additional Benefit Card Request form

Insurance Forms   Top of page

2017 Benefits Newsletter
2017 Choices Booklet
PS 404 Health Insurance Enrollment & Change Form
2017 Health Rates
Empire Plan Out of Network Claim Form
Value Options Claim Form
Empire Plan Flexible Formulary
Pre Tax Contribution Policy
Voluntary Salary Deduction Agreement for Retiree Health
Health Buy Out Summary of Provisions
2017 Health Buy Out Enrollment Form
Metlife Auto and Home Brochure
Metlife Dental Plan Booklet
Metlife Dental Enrollment and Change Form
Metlife Dental Claim Form
Metlife Long Term Disability Certificate
Post Employment Benefit Conversion Form- Life Insurance
Post Employment Benefit Conversion Form- Long Term Disability
Metlife Long Term Disability Enrollment
Short Term Disability Claim Form
Optional Life Insurance Custom Plan Options
Basic Life Insurance & Accidental Life and Dismemberment Insurance- Updated Certificate
Life Insurance Beneficiary Form
Metlife Enrollment Form for Life and Optional Life Insurance
Statement of Health
Optional Life Rate Chart
Critical Illness Insurance Information
Critical Care Enrollment Form
Critical Care Rate Chart
Contact your RFMH Human Resources/Payroll Team   Top of page

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