Forms

Forms are grouped by category:

• HR/PAYROLL FORMS
• EMPLOYMENT
• BENEFITS
• COMPENSATION
• ORGANIZATIONAL
• INFORMATION CHANGES
• AWARDS
• OTHER

HR/PAYROLL FORMS

• Staff Personnel Action Form Form — Instructions
• Exempt Staff Vacation/Leave Reporting Application – MyTimeOff.nd.edu
• Non-Exempt Weekly Report of Absences and Overtime Worked
• Staff Position Management Form

EMPLOYMENT

Employment Eligibility Verification (Form I-9)

Verification is a two-step process: following completion of Section One online, you must present original, unexpired documentation to the Office of Human Resources to complete Section Two.

More about the Employment Eligibility Verification (Form I-9) process.

Tax Withholding Forms

Withholding now online. New hires (or employees who desire to make changes) must make tax withholding elections using the Tax Withholding Elections app on insideND.

• Federal Withholding Instructions (PDF)
• State/County Withholding Instructions (PDF)

Online entry of state/county withholding is available to residents of Indiana and Michigan. University employees who both reside and work outside of Indiana or Michigan should contact Payroll Services at 574-631-7575 prior to submitting their state/county withholding elections.

Direct Deposit

Direct deposit now online. New hires (or employees who desire to make changes) must make direct deposit elections using the Direct Deposit app on insideND.

• Direct Deposit Instructions (PDF).

Recruitment

• Employment Reference Check
• Intent to Employ
• Pre-Employment Screening

Exit Interview

• Exit Interview Form

BENEFITS

Absences and Leaves

• Non-Exempt Weekly Report of Absences and Overtime Worked
• UND Return-To-Work/Work Release form (PDF)
• Military Leave Supervisor Checklist (PDF)
• Absentee and Vacation Reporting Access Form – Absence Reporting (PDF)
• Leave of Absence Form Instructions

Education Benefits

• Degree Seeking Application for Employee and Employee Spouse Educational Benefit (PDF)
• Application for Educational Benefits for Children of Employees (PDF)
• Fred E. Freeman Staff Scholarship Fund Application (PDF)
• Non-Degree Seeking Application for Employee and Spouse Educational Benefit (PDF)
• Non-Notre Dame Tuition Reimbursement (PDF)

Flexible Spending Accounts

• Dependent Care Worksheet
• Health Care Worksheet
• Meritain Flex Spending Account (FSA) Reimbursement Form (PDF)
• Spending Account Direct Deposit Form (PDF)

Group Life Benefits

• Evidence of Insurability – Minnesota Life – 198KB (PDF)
• Group Life & Travel Beneficiary Form Designation (DOC)

Long Term Disability Benefits

LTD claim forms have been eliminated as of July 1, 2015. For information on filing an LTD claim, visit the Long Term Disability page.

Medical, Dental and Vision Benefits

• Benefits Enrollment and Qualifying Event Information
• EyeMed Out of Network Claim Form (PDF)
• Meritain Health Claim Form (PDF)
• Meritain Health Direct Deposit Authorization Form (PDF)
• Delta Dental Claim Form (PDF)

Prescription Drug Benefit

• OptumRX Prescription Home Delivery Form (English) (PDF)
• OptumRX Prescription Home Delivery Form (Spanish) (PDF)
• Member Reimbursement Drug Claim Form (PDF)

Retirement

Employee Contribution Forms

• As of January 2015, voluntary contribution elections are now paperless. To begin, change or cancel your voluntary contributions, log in to netbenefits.com/nd or call Fidelity at 877-963-0242.

Fidelity Forms

• Fidelity Transfer Rollover Form (PDF)
• As of January 2015, many 403(b) processes are now paperless. To change your beneficiaries, contributions or investment elections, log in to netbenefits.com/nd or call Fidelity at 877-963-0242.

Pension Plan Forms

• Beneficiary Designation Form
• Withholding Certificate for Pension or Annuity Payments Form W-4P (PDF)
• Indiana State Withholding Certificate for Pension or Annuity Payments Form WH-4P (Click on WH-4P to access PDF)

Claim Forms

• Prescription Mail Order Form (PDF)

Other

• To request a temporary NetID for an affiliate you will need to complete the Affiliate Access Process. (Notre Dame NetID required)
• Adoption Form

COMPENSATION

Overtime

• Report of Absences and Overtime Worked Form
• Absentee and Vacation Reporting Access Form – Absence Reporting (PDF)

Staff Position Management Form

• Staff Position Management Form

Additional Pay for Services

• Form
• Instructions

ORGANIZATIONAL

Performance

• 90 Day Orientation Review Form (DOC)
• Nonexempt Complaint Procedure Form (DOC)

LifeWorks/Employee Assistance Program

• Release of Information – Management Consultation/Work Issues
• Release of Information – Substance Abuse

INFORMATION CHANGES

Withholding

Withholding now online. New hires (or employees who desire to make changes) must make tax withholding elections using the Tax Withholding Elections app on insideND.

• Federal Withholding Instructions (PDF)
• State/County Withholding Instructions (PDF)

Online entry of state/county withholding is available to residents of Indiana and Michigan. University employees who both reside and work outside of Indiana or Michigan should contact Payroll Services at 574-631-7575 prior to submitting their state/county withholding elections.

• Federal Tax Withholding Form W-4
• Indiana Taxwithholding Form W-4 (Click on WH-4 to access PDF)
• Michigan Form W-4
• Illinois Taxwithholding Form W-4

Personal

• Name and Address Change Form

AWARDS

• Team Irish Award Nominations
• Presidential Award & Notre Dame Award of Merit Nomination – Closed

OTHER

• Employee Compassion Fund Information and Form
• HR Reporting Access Request (People EZ and others)

Send us your comments and questions.