Policies / Forms - Human Resources at Ohio State

• Adoption Assistance Reimbursement Request Form

• Additional Duty Compensation Request

Short and Long-Term Disability

• Accommodation Request Medical Certification
• Benefit Continuation During Approved Family Medical Leave (FML) or Military Leave of Absence
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Long-Term Disability (LTD) Conversion Form
• Long-Term Disability (LTD) Evidence of Insurability (EOI)
• Return to Work Release
• Short-Term Disability (STD) Claim, Authorization – Unum
• Short-Term Disability (STD) Election Form
• Short-Term Disability (STD) Claim, Authorization – University

CCS Disability Separation

• CCS Disability Separation Request
• Integrated Disability Pre-Reinstatement Hearing Waiver
• Request for Placement on Voluntary Disability Separation

Workers’ Compensation

• Accommodation Request Medical Certification
• Benefit Continuation During Approved Family Medical Leave (FML) or Military Leave of Absence
• Employee Accident Report
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Return to Work Release
• Safe Mobility and Repositioning Techniques - Patient Handling Accident Investigation Checklist

Return to Work (RTW)/Remain at Work Accommodations

• Accommodation Request Medical Certification
• Employee Accommodation Request Form
• Leave as an Accommodation Medical Certification
• Return to Work Release

• Please visit the Employee and Labor Relations website for available forms and documents.

Background Check

• Background Check Application
• Background Check Disclosure and Authorization Form
• Fingerprint Consent
• Fingerprint Request

General

• Flexible Work Agreement
• Flexible Work Arrangement Proposal
• Request for Change of Record
• Request for Fitness for Duty
• Request for Prior Service Certification from Another State of Ohio Agency/Institution
• Request for Prior Service Certification from The Ohio State University
• Request for Reduction in Work Force
• Staff External Work Approval Request
• Veterans Post-Offer Self-Identification

Hiring

• Employment Eligibility Verification (I-9) Form (works in IE only)
• Employment Eligibility Verification (I-9) Form - Paper Version
• Employment Eligibility Verification (I-9) Form Instructions
• Equal Employment Identification
• Relocation Allowance Initiation Request
• Relocation Request Form
• Request to Rehire Retired Faculty/Staff Member

• Dependent Care FSA Claim Form
• FSA Election Form
• Health Care FSA Claim Form
• Lifestyle Spending Account Claim Form

• Staff Career Development Grant Application
• Staff Manager Development Grant Application

Benefit Continuation

• Application for Continued Health Plan Eligibility for Over Age Dependents
• Benefit Continuation During Approved Family Medical Leave (FML) or Military Leave of Absence

Medical

• Health Election Form
• Health Election Form (ACA)
• Health Election Form (Graduate Associates)
• HIPAA Privacy Practices
• Out-of-Area Benefit Election Form
• Prescription Drug Home Delivery Form
• Prescription Drug Reimbursement Form
• Trustmark Health Benefits Website Registration
• Trustmark Health Insurance Claim Form
• Trustmark Health Insurance Claim Form - Lactation Services and Hospital Grade Breast Pumps
• Trustmark Hospital Based/Physician Directed Weight Loss Claim Form
• Trustmark Request for Additional Coverage Information

Vacation, Sick and Other Leave

• Benefit Continuation During Approved Family Medical Leave (FML) or Military Leave of Absence

Family and Medical Leave

• Benefit Continuation During Approved Family Medical Leave (FML) or Military Leave of Absence
• FML Certification for Serious Injury or Illness of Covered Servicemember
• FML Certification of Qualifying Exigency for Military Family Leave
• FML Designation Notice
• 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 and Responsibilities
• Leave as an Accommodation Medical Certification
• Return to Work Release

• Group Term Life Insurance (GTLI) Waiver of Entitlement
• Life Insurance Beneficiary Designation
• Retiree Group Term Life Insurance (GTLI) Beneficiary Designation
• Voluntary Group Term Life Insurance (VGTLI) Enrollment Form

General

• ARP Provider Change (via NetBenefits)
• Request for Prior Service Credit Certification
• Retirement Distribution Certificate Request
• Retirement Program Election Form

Ohio Public Employees Retirement System (OPERS)

• Notice of Re-Employment of a OPERS Retiree
• OPERS Authorization for Release of Account Information
• OPERS Independent Contractor Acknowledgement

State Teachers Retirement System (STRS)

• STRS Authorization for Release of Account Information
• STRS Exemption from Contributions for Student Employees Form
• STRS GTA Retirement Election Form
• STRS Reemployed Retiree Notification
• STRS Verification of Employment and Employer Health Care Access

Supplemental Retirement Account (SRA)

• 403(b) – Enroll or update provider/contribution amount (via NetBenefits)
• 457(b) – Enroll or update provider/contribution amount (via NetBenefits) - Note: ODC enrollments and payroll contribution changes must be made directly with ODC at ohio457.org.

Executive Retirement Plans (RCP/415(m))

• 415(m) Distribution Change
• RCP/415(m) Provider Change (via NetBenefits)

Returning Retirees

• Notice of Re-Employment of a OPERS Retiree
• Request to Rehire Retired Faculty/Staff Member
• STRS Reemployed Retiree Notification
• STRS Verification of Employment and Employer Health Care Access

Student Retirement

• STRS Exemption from Contributions for Student Employees Form
• STRS GTA Retirement Election Form

• Certificate of Domestic Partnership for Sick, and Family and Medical Leave

• Graduate Associates, Fellows and Trainees University Health Insurance Subsidy Waiver
• Payroll Deduction of Other Fees for Graduate Associates

• Dependent Tuition Assistance Application
• Faculty and Staff Tuition Assistance Application
• Faculty and Staff Tuition Assistance Request for Course Enrollment During Regularly Scheduled Work Hours
• Non-Employee Dependent Tuition Assistance Application
• Non-Employee Faculty and Staff Tuition Assistance Application
• One-Time-Forgiveness Benefit Application - Faculty and Staff Tuition Assistance Plan