Contents
- Leave Forms
- Benefit Forms
- Adoption
- Benefit Continuation
- Disability Insurance
- Domestic Partnership
- Family and Medical Leave (FML)
- Flexible Spending Accounts (FSA)
- Graduate Associates
- HIPAA Privacy Practices
- Life Insurance
- Medical Benefits
- Retirement
- Returning Retirees
- Sponsored Dependents
- Student Retirement
- Tuition Assistance
- Workers' Compensation
- Employment Forms
- Payroll/HRIS Forms
- Training and Development Forms
- Other Forms
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Forms
The following are many of the forms required by the Office of Human Resources for different programs and services available to Ohio State University employees. For more information about the forms and their use, contact the Office of Human Resources Customer Service Center.
Payroll Services forms are available at the Office of the Contoller web site.
Leave Forms
Vacation/Leave
Benefit Forms
- Continued Health Plan Eligibility for Over Age Dependents
- Benefit Continuation Due to Unpaid Leave of Absence
- Benefit Continuation During Military Leave Election Form
- Long-Term Disability (LTD) Conversion Form
- Short-Term Disability (STD) Enrollment Form (or use eBenefits)
- Short-Term Disability (STD) Evidence of Insurability (EOI)
- Short-Term Disability (STD) Claim, Authorization – Unum
- Short-Term Disability (STD) Claim, Authorization – University
- Long-Term Disability (LTD) Conversion Form
- Fitness for Duty Request Form
- Employee Accident Report
- CCS Disability Separation Request
- Voluntary Disability Separation Pre-Reinstatement Hearing Waiver
- Request for Placement on Voluntary Disability Separation
- Health Election Form (includes sponsored dependents and opposite-sex domestic partners (or use eBenefits))
- Affidavit of Same-Sex Domestic Partnership for Health and Life Insurance
- Affidavit of Domestic Partnership (for sick leave and FML)
- Affidavit of Termination of Same-Sex Domestic Partnership and/or Sponsored Dependency Status (includes opposite-sex domestic partners)
- FML Medical Certification of Health Care Provider for Employee's Serious Health Condition
- FML Medical Certification of Health Care Provider for Family Member's Serious Health Condition
- FML Notice of Eligibility and Rights & Responsibilities
- FML Designation Notice
- FML
- FML Certification of Qualifying Exigency for Military
- Family and Medical Leave Act Poster
- FSA Dependent Care Request for Reimbursement
- FSA Health Care Request for Reimbursement
- FSA Election Form (or use eBenefits)
- Prime Care Advantage Health Plan Enrollment Form
- University Insurance Premium Contribution Waiver
- Authorization to Release Medical Information Form
- Request to Restrict Uses and Disclosure of PHI Form
- Access Request Form
- Accounting Request Form
- Amendment Request Form
- Confidential Communication Request Form
- Privacy Complaint Form
- Member Concern Record
- Life Insurance Beneficiary Designation (or use eBenefits)
- Group Term Life Insurance Waiver of Entitlement
- Dependent Group Life Insurance (DGLI) Enrollment Form (or use eBenefits)
- Voluntary Group Term Life Insurance (VGTLI) Application (or use eBenefits)
- Post-Retirement Life Insurance Change of Beneficiary
- Retiree Group Term Life Insurance Change of Beneficiary
- Retiree Group Term Life Insurance Waiver of Entitlement
- Health Plan Election Form (or use eBenefits)
- Prescription Drug Reimbursement Form
- Prescription Drug Home Delivery Form
- NGS Health Insurance Claim Form
- NGS Claim Form for Weight Watchers
- NGS Claim Form for Hospital Based/Physician Directed Weight Loss
- NGS Request for Additional Coverage Information
- Out-of-Area Election Form
- Retirement Program Election Form | ARP Processing Calendar
- Form SSA-1945: Statement Concerning Your Employment in a Job Not Covered by Social Security
- ARP Provider Change Form
- OPERS Authorization for Release of Account Information
- Supplemental Retirement Account Salary Reduction Agreement (or use eBenefits)
- Request for Prior Service Credit Certification
- Student Retirement Election Form (includes GAAs, GRAs, and GTAs)
- Request for Optional Exemption as a Student (OPERS)
- STRS Authorization for Release of Account Information
- Retirement Disbursement Certification Request
- OPERS Independent Contractor Acknowledgement
- Retirement Program Election Form for Reemployed Retirees
- Notice of Re-employment of a OPERS Retiree
- STRS Reemployed Retiree Notification for College and University Employers
- STRS Verification of Employment and Employer Health Care Access
- Request to Rehire Retired Faculty Member
- Request to Rehire Retired Staff Member
- Health Election Form (includes sponsored dependents and opposite-sex domestic partners (or use eBenefits))
- Affidavit of Sponsored Dependency For Health Care Coverage (includes opposite-sex domestic partners)
- Affidavit of Termination of Same-Sex Domestic Partnership and/or Sponsored Dependency (includes opposite-sex domestic partners)
- Dependent Tuition Assistance Application (or use eBenefits)
- Request for Course Enrollment During Regularly Scheduled Work Hours
- Program Exception Request
- Declaration of Tax Exempt Status for Employee Tuition Waivers
Adoption
Benefit Continuation
Disability Insurance
Domestic Partnership
Family and Medical Leave (FML)
Flexible Spending Accounts (FSA)
Graduate Associates
Student Retirement
HIPAA Privacy Practices
Life Insurance
Group Term Life Insurance
Dependent Group Life Insurance
Voluntary Group Term Life Insurance
Retiree Life Insurance Information
Medical Benefits
Retirement
Returning Retirees
Sponsored Dependents
Tuition Assistance
Workers' Compensation
Employment Forms
- Disclosure, Authorization, and Release Form
- Ineligible for University Employment Due to Falsification – External Candidate
- Ineligible for University Employment Due to Falsification – Internal Candidate
- Adverse Action
- Pre-Adverse Action
- Offer Letter Samples Downloadable, customizable letters for use in the hiring process
- Employment Eligibility Verification (I-9) Form [ I-9 Handbook for Employers]
- Ohio Ethics Law Acknowledgement Form [ Ohio Ethics Law and Related Statutes ]
- Fraud Reporting System Information - Acknowledgement
- Fraud Reporting System Information
- Employment Verification
- Request for Reduction in Workforce
- Employment Dispute Form
- Staff External Work Approval Request
- Editable Full Time Equivalency (FTE) Change Letters (for department HR contacts to use with their customers)
- Position Advertisement Intake Form
- Hire Data Worksheet (or use ESS)
Applications
Background Check
Hiring
Other
Payroll/HRIS Forms
Training and Development Forms
- Personalized Performance Plan (PDF)
- Personalized Performance Plan (MS Word)
Performance Management
Other Forms
- Veteran Self-Identification Form
- Skurow Student Veteran Award Application Form
- Benefit Continuation During Military Leave of Absence
- Whistleblower Report Form
- Fraud Reporting System Information - Acknowledgement
- Fraud Reporting System Information
Classification and Compensation
Immigration
Mediation
Sexual Harassment & Discrimination
Special Events
Veterans Affairs
Whistleblower
Workplace Violence
