HR forms

Access forms, documents and instructions for benefits requests, data management, financial documentation, insurance claims and retirement program administration. Visit the Work Instructions and Information app for more information about changing and managing benefits, leaves of absence and other common HR processes.

The resources on this page are for university staff. Academic personnel can access forms and resources through the Academic Enterprise.

E-fax numbers:

Background checks: 480-993-0006
Benefits and leaves: 480-993-0007
Retirement: 480-993-0008

Benefits and claims

Cobra	Administered by the Arizona Department of Administration, Benefits Services Division. Visit the website for forms and instructions.
Dental, medical and vision claims	Submit a Delta Dental claim. Submit a medical claim to Blue Cross Blue Shield of AZ. Submit a medical claim to UnitedHealthcare. Submit an out-of-network vision benefits claim.
Family adoption and fertility benefits	Request an adoption benefits subsidy. Request a fertility benefits subsidy.
Flexible Spending Accounts	Submit claims using the General FSA Claim Form. Sign up for direct deposit and email notifications about account activity.
Prescription management	Register for prescription mail order through MedImpact. Request prescription reimbursement.
Qualified Tuition Reduction	Apply and learn more about how to get reduced in-state tuition for qualifying courses at any of the three public Arizona universities.
Unum beneficiary designation	Designate a beneficiary for your Unum short-term, life or AD&D insurance policies.

Data management and financial documentation

Pay option agreement	Request change in pay schedule — faculty and academic professionals on academic year appointments only.
Personnel file request	Request access to view an employee’s personnel file.
W-2 request	Request a duplicate copy of a W-2 or 1042S.

Retirement programs

ADOA retiree health insurance	Enroll for retiree health insurance, administered by the Arizona Department of Administration, Benefit Services Division.
Arizona State Retirement System	Request a name change in the ASRS system. Request reimbursement of medical and dental costs. Return to work for ASRS employer. Submit an affidavit of military service. Submit an affidavit of public service. Submit ASRS 65 and older membership waiver within 30 days of employment. Withdraw funds and terminate ASRS membership.
Public Safety Personnel Retirement System	Find PSORS administration and enrollment forms for beneficiary designation, new membership and requesting a name change or refund.
Retiree accumulated sick leave	Submit the following to OHR within 150 days of retiring: Arizona A-4. Federal W-4. RASL application and checklist forms.