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