SUNY Potdam

General

• Accident/Injury report (on the job)
• Change of Address
• CSEA Hardship
  

Appointment

• Demographic Form (to be completed by new employees and those changing personal information)
  
• W-4 Federal Withholding
• IT 2104 NYS Withholding
• I-9 (must be completed no later than 3 days after appointment)
• Oath of Office
• Extra Service
  

Annual Evaluations/Performance Programs

Classified Service Staff

• Classified Probation Report
  
• Performance Program and Evaluation - CSEA
• Performance Program and Evaluation - Security Services Unit
  

Professional Employees

• Performance Program-Professional UUP and M/C
• Annual Evaluation-Professional UUP
• Annual Evaluation-M/C

Reappointment

• Academic Faculty Information Form (PDF)
• Academic Faculty Information Form (Word)
  
• Personnel Action-Academic
• Personnel Action-Dept. Chair
• Personnel Action-Professional
• Reappointment Schedule
  

Benefits Forms

Health Insurance:

• Health Insurance Transaction Form (PS-404), Instructions
• United Health Care Claim Form
• Medco by Mail form and Questionnaire
• Medco Reimbursement Form

Dental

• CSEA-dental claim form
• UUP-dental claim form
• M/C/PEF/ALESU-dental claim form

Vision

• No forms or identification cards are required. Visit the network provider of your choice, identify yourself as a NYS employee or dependent, and provide the requested information. The provider’s office will contact the insurance and verify eligibility for services.
  

Retirement

• ERS-Employees Retirement System forms page
• TRS-Teacher's Retirement System forms page
• SUNY ORP (Optional Retirement Plan)-TIAA-CREF/ING/VALIC/Met Life/Fidelity
  

Leaves

• Leave of Absence Form (for Family medical, Military, leave without pay and other)
• FMLA Heath Care Provider Certification-for Employee leave
• FMLA Heath Care Provider Certification-for family member leave
• Leave Donation Form
• Drescher Leave
• Parental Leave Request Form
• Sabbatical Leave-use Personnel Action-Academic
• Title F Leave-use Personnel Action-Professional

Payroll

• Direct Deposit Form
• Holiday Pay Form
• Hourly Time Sheets (non-student) and Schedule of Due dates/Paycheck dates
• Leave Donation Form
  
• Paycheck Distribution (authorizes someone else to pick up your check)
• W-4 Federal Tax Withholding
• IT 2104 NYS Tax Withholding
• IT 2104 NYS E Certificate of Exemption for Withholding

• Extra Service-for work at home campus (Potsdam)
• Extra Service M/C employee-UP 6
• Extra Service UUP employee-UP 8 (for work at other than home campus)
• Extra Service/Dual Employment form-for Non-SUNY Employees
• Extra Service Voucher