Office of Human Resources|

Payroll Forms

Form W-4 (2008)| (PDF)

Form WH-4 (State of Indiana)| (PDF)

I-9| (PDF)

Direct Bank Deposit|

Certificate of Residency - (Kentucky)| (PDF)

Hourly Temporary Position Form| (PDF)

International Tax Questionnaire| (PDF)

Personal Profile Form (Change Form, Personal Data)| (PDF)

Job Classification-Based Forms

• Position Description Document (.doc)
  • for classifed staff : PA, CL/TE, SM
  • Instructions for Reclassification|
    
• Essential and Marginal Functions worksheet (PDF)
  • (Supplement to the Position Description Document)
    
    
• Appeals form (PDF)
  • Instructions for the appeals process on all Indiana University campuses(PDF)
    

Employee Status Forms

• Employee Change of Status Form (PDF)
• Family Medical Leave Act (FMLA) Information and Forms
• Workers Compensation Information

Employee Benefits Forms

FEE COURTESY

IU Fee Courtesy 2008-2009 Benefit Enrollment Form

 

HEALTH, DENTAL & PRESCRIPTION PLANS

Medical Care

IU PPO Plus, IU PPO $900 Deductible and Blue Preferred POS Plans

Medical Claim Form (Anthem) (PDF)

Retiree Health Care Enrollment Form (under age 65) (PDF)

Prescription Plan

IU PPO Plus, IU PPO $900 Deductible, Blue Preferred Primary POS

Anthem Prescription Order Form (PDF)

Anthem Prescription Claim Form (PDF)

Mental Health and Chemical Dependency

IU PPO Plus and IU PPO $900 Deductible

Indiana University Psychiatric Management (IUPM) Claim Form (PDF)

Dental Plan

Dental Claim Form (CIGNA) (PDF)

 

INSURANCE PLANS

Supplemental Life Insurance

Change of Beneficiary Designation (PDF)

Basic Life Insurance Plan

Beneficiary Designation (PDF)

Personal Accident Insurance (PAI)

Enrollment/Beneficiary Change

 

RETIREMENT

IU Retirement Savings Plan 457(b)

Salary Deferral Agreement Form (PDF)

Fidelity Investments 457(b) Enrollment Form and Beneficiary Designation (PDF)

Your 457(b) Enrollment Form (TIAA-CREF) (PDF)

IU Tax Deferred Annuity Plan 403 (b)

Salary Deferral Agreement (PDF)

Account Application Fidelity Investments 403(b) Custodial Account (PDF)

Your GRSA Enrollment Form (TIAA-CREF) (PDF)

Public Employee's Retirement Fund (PERF)

Investment Direction Form (PDF)

 

TAX SAVER BENEFIT (TSB) PLAN

Claim Form (PDF)

Direct Deposit Authorization/Termination form

Dependent Care Flexible Spending Account Worksheet (PDF)

Health Care Flexible Spending Account Worksheet (Nyhart) (PDF)

See the Benefits Change Connection about making changes to your plan

Other Forms

Forms available on the Indiana University Bloomington: University Human Resources website.