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 Grievance Form
Employee Information Change Form
Exit Survey
FMLA Employee Information on the Family Medical Leave Act
Completing Your Hourly Voucher
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
Voluntary Self Identification of Disability

TIAA Retirement Forms Top of page

Request for Retirement Service Credit
Roth Contribution Option
Managing Contribution Changes
SRA Custodial Agreement and Verification forms
TIAA Designation of Beneficiary
TIAA Online Enrollment
NEW effective 1/2/2023 Auto Enrollment into SRA

Tax Forms Top of page

2024 W-4 Employee's Withholding Certificate
2024 IT-2104 NYS Withholding Allowance Certificate
2024 IT-2104E NYS Certificate of Exemption from Withholding
IT-2104.1 NY Certificate of Nonresidence
Online W2 Enrollment
BDS Link

Flex Plan Forms Top of page

Dependent Care W-10 Form
Instructions for online access to your account
Mobile Pay FAQ
DAC online
2024 Transportation & Parking Enrollment Form
2024 Health Flex & Dependent Care Enrollment Form
2023 Healthflex Reimbursement Form
2023 Dependent Care Reimbursement Form
Parking Reimbursement Form
2024 Healthflex Reimbursement Form
2024 Dependent Care Reimbursement Form
2023 Health & Dependent Care Qualifying Event Change Form
Commuter Benefits FAQ
Commuter Ride Share Information
Over the Counter Health Flex Updates Due to Covid
RFMH Parking and Transportation Plan Document
Dependent Care FAQ's
FAQ's for Flexible Spending Accounts
Debit Card Info Insert
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

2024 Health and Dental Rates
2023 Health & Dental Rates
2023 Empire Plan Special Report -Special Option Transfer Period NEW UPDATES June 2023    
2023 Empire Plan Summary of Benefits and Coverage      
Empire Plan Telehealth Services Memo
Empire Plan Telehealth Services Instructions
Empire Plan LiveHealth Online Memo
Empire Plan LiveHealth Online Instructions
2024 Benefits Newsletter
NYSHIP General Information Book
2024 At A Glance
2024 Choices
PS 404 Health Insurance Enrollment & Change Form
Formulary Documents-NYSHIP site
Empire Plan Flexible Formulary Preferred Drug List
Empire Plan Preventive Care Coverage Guide
2019 Empire Plan Supplement
Empire Plan Out of Network Reimbursement Disclosures
Empire Plan Certificate for Participating Employers

Empire Plan Health Insurance Claim Form-Medical/Surgical Program

Value Options Claim Form
Empire Plan Prescription Drug Program Reimbursement Claim Form Prescription Drug Program
Mental Health And Substance Use Program Mental Health and Substance Use Claim Form
Pre Tax Contribution Policy
Voluntary Salary Deduction Agreement for Retiree Health
Health Buy Out Summary of Provisions
2024 Health Buy Out Enrollment Form
Waiver of Health, Dental and/or Vision Coverage Form
MetLife Mobile App
How to register for MetLife MYBenefits
Vision and Legal Benefits
Metlife Vision Benefits Overview
Vision Insurance Overview (video)
How to Find a Vision Provider (video)
Metlife Vision Enrollment Form (fillable)
Vision Claim Form
Eye Exam - What is Covered?
Legal Plan General Introduction
MetLaw Summary of Benefits
MetLaw Enrollment Form
Legal Fee Schedule
Legal Facts and Stats
Legal Fact Sheet
Legal FAQ
Legal Certificate of Coverage
Family Matters Brochure
Digital Estate Planning
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
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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