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Form directions and/or additional information are provided in the Instructions or Information Column or within the form.
Technical
Support for
Forms:
Kathy Kugle
(785) 532-1885
or
email
kkugle@ksu.edu
Refer to unclassified transactions for personnel and payroll forms. Refer to summary of benefits for unclassified faculty and staff for benefits forms.
| FORMS by Name | Dated | Instructions or Information |
Versions | |||
|---|---|---|---|---|---|---|
| Accident/Injury Report (PER-17) (Workers' Compensation) | 02/2007 | PPM 4820.100 | RTF | Word | ||
| Additional Pay | 01/2007 | Faculty
Awards PPM 4650.110 | RTF | Word | ||
| Additional Pay Checklist #1 | 4/2001 | Faculty
Awards PPM 4650.110 |
RTF | Word | ||
| Additional Pay Checklist #2 | 04/2005 | Faculty
Awards PPM 4650.110 |
RTF | Word | ||
| Administrative Leave Reporting | 6/2003 | PPM 4860.20 | RTF | Word | ||
| Affiliated Person or Emeritus Faculty Form (PER-22) | 7/2006 | Included | RTF | Word | ||
| Agency Payroll Deduction Authorization | 5/2007 | Agency Payroll Deductions | RTF | Word | ||
| Agreement of Understanding for Overlapping Appointment (PER-28) | 10/2004 | Military Service Policy | RTF | Word | ||
| Agreement for Reimbursement of Moving Expenses(DA-22) | 11/1998 | Moving Expenses | RTF | Word | ||
| Application for Tuition Assistance (PER-32) | 05/2007 | PPM 4870.30 | RTF | Word | ||
| Appointment Form (PER-38) | 04/2008 | 4650.090 | RTF | Word | ||
| Authorization to Release Information | 10/2004 | PPM 4010 | RTF | Word | ||
| Beneficiary Designation (KPERS-7/99) | 07/2006 | PPM 4820.60 | ||||
| Change or Separation Form (PER-39) | 12/2006 | Unclassified | RTF | Word | ||
| Conflict of Interest Form | Conflict of Interest Policy | Online | ||||
| Delta Dental Claim Form | 06/2002 | Dental Insurance | ||||
| Designation of Beneficiary (KPERS-7/99) | 07/2006 | PPM 4820.60 | ||||
| Direct Deposit of Employee Pay (PER-58) | 12/2007 | Instructions Information |
RTF | Word | ||
| Documentation of Service for Immediate Participation in Regents Retirement Program (PER-33) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Duplicate W-2 Request Form | Information | RTF | Word | |||
| Educational Authorization Form (PER-25) | 5/1998 | PPM 4870.20 | RTF | Word | ||
| Emeritus Faculty or KSU Affiliated Employee Form (PER-22) | 7/2006 | Included | RTF | Word | ||
|
Employee Performance Review System- Employee Performance Review (PER-47) |
03/2006 | Instructions Presentation in PPT Supervisor's Guide - Action Steps (PDF) Training |
RTF | Word | ||
|
Employee Performance Review System- Employee's Annual Report of Activities (PER-48) |
09/2004 | Instructions Presentation in PPT Supervisor's Guide - Action Steps (PDF) Training |
RTF | Word | ||
|
Employee Peformance Review System- Professional Development and Growth Plan (PER-49) |
09/2004 | Instructions Presentation in PPT Supervisor's Guide - Action Steps (PDF) Training |
RTF | Word | ||
|
Employee Performance Review System- Performance on Goals and Projects (PER-50) |
09/2004 | Instructions Presentation in PPT Supervisor's Guide - Action Steps (PDF) Training |
RTF | Word | ||
| Employee Separation Checklist (PER-24) | 02/2008 | Classified
Separations Unclassified Separations PPM 4950 | RTF | Word | ||
| Employment Eligibility Verification (I-9) | 06/2008 | Instructions | ||||
| Exit Interview Letter at Resignation | 06/2007 | PPM 4950 | ||||
| Exit Interview Letter at Retirement | 06/2007 | PPM 4950 | ||||
| Faculty and GTA Spoken English Competency Assessment Sheet (PER-20) | 01/2007 | 4650.075 | RTF | Word | ||
| Family and Medical Leave Act (FMLA) Certification of Health Care Provider | Classified PPM 4860.50 Unclassified PPM 4865.60 |
RTF | Word | |||
| Family and Medical Leave Act (FMLA) Employee Request Form | 01/2007 | Classified PPM
4860.50 Unclassified PPM 4865.60 | RTF | Word | ||
| Family and Medical Leave Act (FMLA) Employer Checklist | 01/2007 | Classified PPM
4860.50 Unclassified PPM 4865.60 |
RTF | Word | ||
| Family and Medical Leave Act (FMLA) Notice of Designation of FMLA Leave | 01/2007 | Classified PPM
4860.50 Unclassified PPM 4865.60 |
RTF | Word | ||
| Family and Medical Leave Act (FMLA) Notice to Employees Requesting FMLA | 5/1999 | Classified PPM
4860.50 Unclassified PPM 4865.60 |
RTF | Word | ||
| KSU Foreign National Tax Information Form (PER-15) | 07/2007 | Visa Classifications | RTF | Word | ||
| Funding Data Sheet (PER-44) | 06/2005 | Instructions | RTF | Word | ||
| Health Care Selection Form | 06/2003 | Health Insurance | ||||
| Health Insurance Affidavit of Common Law Marriage and Request for Enrollment of Common Law Spouse | 02/2008 | Health Insurance | ||||
| Health Insurance Application for Coverage of Handicapped Dependent Child | 02/2008 | Health Insurance | ||||
| Health Insurance Communication Form | 02/2008 | Health Insurance | ||||
| Health Insurance Dependent Grandchild Affidavit | 02/2008 | Health Insurance | ||||
| HIPAA- Authorization Form for Release of Medical Information | 03/2008 | Health Insurance | ||||
| Health Savings Account Enrollment & Change Form | 02/2008 | Health Insurance | ||||
| Health Savings Account Enrollment Form UMB Bank | 02/2007 | Health Insurance | ||||
| HealthyKIDS Application | Fact Sheet(pdf) | |||||
| Health Insurance Claim Form (State of Kansas) | 1/1998 | Health Insurance | ||||
| Health Insurance Communication Form | 3/2003 | Health Insurance | RTF | Word | ||
| HRIS/PeopleSoft Access Form | Instructions (pdf)
HRIS Roles |
RTF | Word | |||
| HRIS Problem Investigation Request Fax Form | 11/1996 | RTF | Word | |||
| Intellectual Property Agreement | Information | RTF | Word | |||
| Investment Agreement - Mandatory Retirement Plan (Kansas Board of Regents) (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Investment Agreement - Voluntary Retirement Plan (Kansas Board of Regents) (PER-19) | 01/2007 | PPM 4810.80 | RTF | Word | ||
| KanElect Claim Form | 1/2004 | Flexible Spending Accounts | Word | |||
| KanElect Direct Deposit/E-Mail Notification Form | Flexible Spending Accounts | Word | ||||
| Kansas Board of Regents Mandatory Retirement Plan Investment Agreement (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Kansas Board of Regents Voluntary Retirement Plan Investment Agreement (PER-19) | 01/2007 | PPM 4810.80 | RTF | Word | ||
| Kansas Employee's Withholding Allowance Certificate (K-4) | 09/2007 | Information | ||||
| Learning Quest Direct Investment Form | Information | |||||
| Learning Quest Payroll Deduction Change Form | Information | |||||
| Leave Balance Correction Sheet (PER-9) | 5/2001 | Information | RTF | Word | ||
| Leave Record | 06/2008 for FY 2009 |
Instructions | RTF | Word | Excel | |
| Leave Request-Salaried (Exempt) Faculty and Staff | Instructions | Online | ||||
| Leave-Sabbatical Leave Application Form | Guidelines | Online | ||||
| Life Insurance Beneficiary Designation Form (TEA) | 07/2001 | Included TEA Life Insurance |
||||
| Life Insurance Enrollment Form (TEA) | TEA Life Insurance | |||||
| Life Insurance Request to Change or Cancel Insurance Policy Form (TEA) | TEA Life Insurance | |||||
| Life Insurance Statement of Health (TEA) | TEA Life Insurance | |||||
| Mid Year Base Salary Increase Form (PER-46) | 12/2003 | Included | RTF | Word | ||
| Mileage Reimbursement Form (Workers' Compensation) | Information | RTF | Word | |||
| New Course Data Sheet | 2/2006 | Instructions (PDF) | RTF | Word | ||
| New Employee Orientation Forms Checklist | 11/2001 | PPM 4070 | RTF | Word | ||
| 9 Month Unclassified Summer Transactions (PER-45) | 04/2008 | Instructions | RTF | Word | ||
| Non-Resident Alien Forms | Non-Resident Alien Employment | |||||
| Notification of Retirement (PER-37) | 1/2002 | PPM 4810 | RTF | Word | ||
| Orientation Forms Checklist | 11/2001 | PPM 4070 | RTF | Word | ||
| Paycheck Stop Payment Request (DA-6P) | 05/2006 | Information | Excel | |||
| Position Description (Unclassified Professional Positions) (PER-23) | 02/2007 | Instructions Position Descriptions Checklist |
RTF | Word | ||
| Position Data Sheet (PER-36) | 02/2007 | 4650.140 | RTF | Word | ||
| Prescription Claim Form | Prescription Drug Program | |||||
| Prescription Drug Advance Purchase Certificate | 03/2008Advance Purchase Policy(pdf) | |||||
| Prescription Drug Program Grievance Form | 2/1996 | Prescription Drug Program | RTF | Word | ||
| Report/Labels Request | Reports(Ad hoc) | RTF | Word | |||
| Retirement Notification (PER-37) | 1/2002 | PPM 4810 | RTF | Word | ||
| Retirement Plan Investment Agreement - Mandatory (Kansas Board of Regents) (PER-13) | 01/2007 | PPM 4810.20 | RTF | Word | ||
| Retirement Plan Investment Agreement - Voluntary (Kansas Board of Regents) (PER-19) | 01/2007 | PPM 4810.80 | RTF | Word | ||
| Savings Bond Payroll Savings Authorization (PER-14) | 01/2007 | U.S. Savings Bonds | RTF | Word | ||
| Shared Leave Donation Form | 8/2001 | Classified PPM
4860.140 Unclassified PPM 4865.140 | RTF | Word | ||
| Shared Leave Request Form | 10/2007 | Classified PPM
4860.140 Unclassified PPM 4865.140 |
RTF | Word | ||
| Substance Abuse Policy Affirmation Form | 8/2002 | Information | RTF | Word | ||
| Supplemental Pay Form (PER-8) | RTF | Word | ||||
| Tax Clearance Information Form for Candidates and New Hires (DA-2004a) | 05/2004 | Information | ||||
| TEA Life Beneficiary Designation Form | 07/2001 | Included TEA Life Insurance |
||||
| TEA Life Insurance Enrollment Form | TEA Life Insurance | |||||
| TEA Life Insurance Request to Change or Cancel Insurance Policy Form | TEA Life Insurance | |||||
| TEA Life Insurance Statement of Health | TEA Life Insurance | |||||
| Tuition Assistance Application (PER-32) | 05/2007 | PPM 4870.30 | RTF | Word | ||
| U.S. Savings Bond Payroll Savings Authorization (PER-14) | 01/2007 | U.S. Savings Bond | RTF | Word | ||
| Workers' Compensation Accident/Injury Report (PER-17) | 02/2007 | PPM 4820.100 | RTF | Word | ||
| Workers' Compensation Mileage Reimbursement Form | Information | RTF | Word | |||
|
W-4 Employee's Withholding Allowance Certificate OR Update online in Employee Self Service |
2008 | Included Information |
||||
|
Withholding form Kansas Employee's Withholding Allowance Certificate (K-4) |
09/2007 | Information | ||||
| W-5 Earned Income Credit | 2008 | Included Information |
||||
| W-9 Request for Taxpayer Identification Number and Certification | 10/2007 | Included | ||||
