*** Forms updated as of Jan-2011 (for Word format, save the file to your computer and edit from Word not Internet Explorer.)Benefits Forms
- Aetna Medical Claim Form
- Application to Dedicated Leave
- Application to Receive Dedicated Leave
- Bargaining Unit Exclusion Form for Instructional Staff
- Certification of Employment Under Section 212 for Members of the Optional Retirement Program
- Classified Staff Agency Shope Fee Authorization Form
- CUNY Dedicated Sick Leave Policy
- CUNY Employee Tuition Waiver Form
- CUNY Phased Retirement Faculty Application
- CUNY Phased Retirement Professional Staff Application
- DC37 Union Membership Form
- Domestic Partnership Registration for Bereavement Leave
- Fellowship Leave Application
- Flexible Spending Accounts Enrollment/Change Form
- General Employment Application
- GHI Health Insurance Claim Form HCFA-1500
- Health Benefits Buy-Out Waiver Form
- HEO CLT Application and Guidelines (Professional Development)
- Instructions for the Addition of Domestic Partners to City Health Plan Coverage
- Long-Term Disability Benefits Claim Packet (Instructional Staff)
- My Benefits at a Glance Form
- New Employee HIP HMO Opt-Out Request Form
- NYC Young Adult Coverage Age 29 Forms
- Paid Family Leave Guidelines for PSC
- Partial Leave With Partial Pay
- Professional Development Funds Application (HEO & CLT Title series)
- PSC Agency Shop Fee Authorization Form
- PSC-CUNY Welfare Fund Optical Reimbursement Form
- Retiree Change of Address Form
- Retirement Leave of Absence (Instructional Staff)
- Revised Paid Parental Leave Policy Memo
- SC-PFL-Bonding Application
- SC-PFL-Care For Family Application
- SC-PFL-Military Application
- Scholar Incentive Award Application
- Short-term Disability Benefit Claim Form (DC 37)
- Special Leave for Child Care (Unpaid) Application
- Special Leave of Absence Without Pay
- TIAA-CREF Contributions on Multiple Positions Form
- TRS Certification of Employment Under Section 212 / IA8 Form
- Tuition Waiver Request Form
- Unpaid Child Care Leave Form
- Welfare Fund Enrollment Form
- Family Medical Leave Act (FMLA) Policy
- Notice of Eligibility and Rights and Responsibilities
- FMLA Request Form
- Designation Notice
- Fitness for Duty Certification
- Certification of Family Relationship Form
- Certification of Health Care Provider (HCP) for Employee's Serious Health Condition
- Certification of Health Care Provider (HCP) for Family Member's Serious Health Condition
- Certification for Serious Injury or Illness of a Current Service Member - Military Family Leave
- Certification for Serious Injury or Illness of a Veteran - Military Caregiver Leave
- Certification of Qualifying Exigency for Military Family Leave