HR & Payroll / Forms & Policies

Employee/Payroll Forms Bottom 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
New Fillable Form - 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 Form
Performance Evaluation Employee Self Analysis Form
Professional Liability Questionnaire
Promotion Request Worksheet
Request for a Replacement Check
RFMH Salary Plan Document
Request to Post Job Form
Veteran Designation Form

TIAA Retirement Forms Top of page

Request for Retirement Service Credit
SRA Salary Reduction Agreement
Roth Contribution Option
Roth Flyer
SRA Custodial Agreement and Verification forms
TIAA Designation of Beneficiary

Tax Forms Top of page

2019 W-4 Employee's Withholding Allowance Certificate
2019 IT-2104 NYS Withholding Allowance Certificate
2019 IT-2104E NYS Certificate of Exemption from Withholding
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
2019 Health Flex & Dependent Care Enrollment Form
2019 Transportation & Parking Enrollment Form
2019 Healthflex Reimbursement Form
2019 Dependent Care Reimbursement Form
2019 Health & Dependent Care Qualifying Event Change Form
2018 Healthflex Reimbursement Form
2018 Dependent Care Reimbursement Form
2018 Parking 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

2019 Health & Dental Rates
2019 Benefit Newsletter
NYSHIP General Information Book
2019 Empire Plan Flexible Formulary
2019 Empire Plan Supplement
2019 NYSHIP Choices
PS 404 Health Insurance Enrollment & Change Form
Empire Plan Certificate for Participating Employers
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
2019 Health Buy Out Enrollment Form
Waiver of Health, Dental and/or Vision Coverage Form
Vision and Legal Benefits
Metlife Vision Benefits Overview
Metlife Vision Enrollment Form
Vision Claim Form
Eye Exam - What is Covered?
MetLaw Summary of Benefits
MetLaw Enrollment Form
Hyatt Legal Fee Schedule
Hyatt Legal Fact Sheet
Legal Certificate of Coverage
Family Matters Brochure
LifeStages Identity Management Services Brochure
Vision and Legal Presentation
Frequently Asked Questions
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
Paid Family Leave Benefit Available as of January 1, 2018
Information Guide
Employee Rights
Contact your RFMH Human Resources/Payroll Team Top of page

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