Office of the Vice President for Information Technology
University Information Technology Services
Human Resources Office

Commonly used Transactions Forms

Some of these are web-based submission forms. Most are forms to be printed, filled out and sent in for processing. Some of these require the use of Adobe Acrobat. Unless otherwise indicated, the form displayed is the same for both campuses. Please contact Toni Usrey for further assistance or with suggestions.

Employment related

• Employee Change Personal Data Form (change of address)

• Direct Deposit form

• I-9 Employment Verification form

• Federal tax Withholding form (electronic version) or
  Federal Tax Withholding form (paper version)

• State of Indiana Tax Withholding Allowance worksheet

• Business cards order form

• UITS Personnel Hiring Request Form

• Online User Agreement form

Employee Benefit related

• Tuition discount form    IUB (online submit)    IUPUI     

• Anthem Medical Claim Form

• Anthem Drug Formulary Quick Reference

• Anthem Prescription Drug Claim Form(all PPO plan members)

• Mail Order form/instructions for Anthem Prescriptions (for all PPO plan members)

• Tax Saver Benefit Site exclusively for IU.(Site includes claim forms, eligible expenses list, debit card request, etc)

• Dental Claim Form

• Cigna Dental Membership Card

• Group Life Insurance Beneficiary Designation

• Supplemental Life Insurance Enrollment

• Supplemental Life Insurance Beneficiary Designation

• Employee Statement of Health

Employee Relations related

• FMLA Department of Labor Poster

• FMLA Request Form   IUB/IUPUI     

• FMLA Medical Certification form - Employee caring for themselves    IUB/IUPUI    

• FMLA Medical Certification form - Employee caring for family member    IUB/IUPUI    

• Certification of Qualifying Exigency for Military Family Leave

• Certification for Serious Injury or Illness of Covered Service Member

• FMLA Release/Intent to Return to Work form      IUB/IUPUI   

• Occupational Injury form for all IU campuses and contact Toni Usrey or Lynda Johnson to submit online form for University Risk Management case processing.

• Grievance Form - Professional Staff      IUB      IUPUI   

• Grievance Form - Support Staff      IUB      IUPUI   

• Grievance Form - Hourly      IUB      IUPUI   

• Benefits

• UITS Staff Handbook

• Commonly Used Forms

• UITS Phonelist

• UITS Organizational Charts

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• UITS Services and Support
• Vice President for Information Technology
• OVPIT/UITS HR

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• Last updated: 15th March 2011