Forms
By U Number
- U280 — Employee-initiated Reduction in Time Program — Contract
- U281 — Employee-initiated Reduction in Time Program — Contract Amendment
- U560/644 — Multi-Location Appointment/Interlocation One-Time Payment Form
- U5605 — Demographic Data Transmittal (Spanish Version)
- UBEN138 — Retired Employee Approvals Form
University Benefits
- UBEN 100 — Retiree Continuation, Enrollment, or Change — Medical, Dental and/or Legal Plan
- UBEN 101 — Medicare Advantage Prescription Drug Plan Disenrollment Form
- UBEN 106 — Tax Withholding Election for UCRP Income
- UBEN 106 NR — Tax Withholding Election — Nonresident Aliens
- UBEN 109 — Notice to UC of a COBRA Qualifying Event
- UBEN 116 — Designation of Beneficiary — Employees
- UBEN 117 — Designation of Beneficiary — Retirees, Former Employees and Others
- UBEN 119 — Designation of Alternate Beneficiary — Expanded Dependent Life and AD&D
- UBEN 121 — Enrollment Form for UC Medicare Choice
- UBEN 123 — Blue Cross MedicareRx with Senior Rx Plus Enrollment Form for UC Medicare PPO or UC High Option Supplement to Medicare
- UBEN 127 — Medicare Advantage Universal Enrollment/Election Form for Kaiser Senior Advantage
- UBEN 131 — Address Change Notice for Retirees/Survivors and Former Employees
- UBEN 132 — Service Credit Verification Request — UCRP
- UBEN 250 — Declaration of Domestic Partnership
- UBEN 253 — Termination of Domestic Partnership
- UBEN 254 — Exclusively Represented Academic Student Employee (ASE) Child Care Reimbursement
University of California Retirement System
- UBEN 142 — Distribution Request — Refund of Accumulations
- UBEN 142 CAP — Distribution Request — CAP Balance
- UBEN 300 — Pension Choice Covered Compensation Limit for Reciprocal CalPERS Classic Members
- UCRS 169 — Service Credit Purchase Information Request Form
- UCRS 160 — Enrollment, Change or Cancellation — Direct Deposit
- UCRS 216 — Election to Change Primary Retirement Benefit from Savings Choice to Pension Choice
- UCRS 419 — Statement — Employment not Covered by Social Security
University Payroll
- UPAY 585 — State Oath of Allegiance, Patent Policy, and Patent Acknowledgement
- UPAY 884 — Pretax Transportation Program Fact Sheet
- UPAY 886 — Declaration of Tax Dependency for Domestic Partner and/or Domestic Partner's Child and/or Grandchild
- UPAY 919 ASE/GSR — DepCare FSA Enrollment, Change or Cancellation — Salary Reduction Agreement for Academic Student Employees
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