Health Care | Naming Beneficiaries | Domestic Partnerships | Retirement Plans | Tuition Remission | Voluntary Benefits

Workday List Request

FMLA Leave of Absence | Non-FMLA Leaves of Absence | Return to Work Certification

Drug Testing Consent Form | Interview Summary Form

Business Justification Form | Job Evaluation Packet

Revised Timesheets | Tax Forms | Miscellaneous

Telecommuting Program

Volunteer Form

Influenza Vaccination Request for Religious Exemption | Nursing Mother Accommodation Request | PAS-35 (for use by faculty)

Some forms on this page are in Portable Document Format (PDF). To be able to view them you may have to download and install Adobe Acrobat Reader.


Health Care
Aetna Rx Home Delivery
FSA Healthcare Reimbursement Form (If you do not have Adobe Acrobat, you must print this form to complete it.)
FSA Dependent Reimbursement Form (If you do not have Adobe Acrobat, you must print this form to complete it.)
Aetna Medical Claim Form
Aetna Rx Claim Form
Delta Dental Claim Form
Aetna Precertification Rx Form
**Workday Tip Sheets - Click here for Workday tip sheets on how to enroll in benefits as a new hire, view/change existing benefits, and view/change enrolled dependents.

Naming Beneficiaries
Beneficiary designations for active employees must be completed on Workday.
Employees' Retirement Plan Spousal Consent Form
**Employees who have separated from service must contact HR-Benefits at 305-284-3004 or complete the online form at to request a paper beneficiary form.

Domestic Partnerships Certification of Domestic Partnership (not required if legally married)
Termination of Domestic Partnership
Domestic Partnerships Q&A

Retirement Plans
Click to enroll in the Retirement Savings Plan.
Click to enroll in the Supplemental Retirement Annuity.

Tuition Remission
Graduate Tuition Remission Taxation Estimate
Spouse/Dependent Graduate Tax Estimate

Voluntary Benefits
Short-Term Disability Initial Claim Form
Short-Term Disability Follow-Up Claim Form
Voluntary Accidental Death and Dismemberment Application
Excess Life Enrollment Form
Long Term Care Enrollment Form (employee and spouse/domestic partner)
Long Term Care Enrollment Form (eligible family members)
Long Term Care Evidence of Insurability
Voluntary Benefits Cancellation Form

Distribution List Request

List Request Form
handled through Workday

Leave Requests

FMLA Leave of Absence
FMLA Leave of Absence

Non-FMLA Leaves of Absence
Administrative | Contract Class | Educational | Mandatory | Military | Personal

Return to Work Certification
Return to Work Certification
This form is used by an employee returning to work from FMLA leave, other medical leave, use of sick time, or similar occurrence. This form must be provided to Human Resources directly, and not the employee’s supervisor.

New Hire Documents

Drug Free Workplace for Cause Testing Informed Consent
Use these forms for all newly hired and rehired employees.
Coral Gables/RSMAS
Miller School

Interview Summary Form
Interview Summary Form
Use this form to complete the recruitment process.

New Position Requests

Business Justification Form (Miller School Campus)
Use this form to submit a request for a new position within your area.
Job Evaluation Packet
Includes the process and form for supervisors to request review of a job within the new structures and grades. The process includes a systematic review of assessing the relative worth of a job based on the job responsibilities, level of complexity, potential impact to the university and the education and experience requirements.


Time Sheets
UM Revised Timesheet
UM Revised Timesheet-Hospital Employees UM Revised Timesheet-Nursing Employees
UMH Retroactive Payroll Correction Form

Tax Forms
1042s Request
W-2 Duplicate Request
W-7 (Used by a foreign student or visitor to apply for an individual taxpayer identification numbers)
W-8 BEN (Used by non-resident aliens to claim a tax treaty exemption and/or to claim foreign status. See instructions at
W-4 (To be completed in Workday. View tip sheet here.) Foreign National Information (To be completed by foreign students and employees on visa types “F,” “J,” or “H” to determine residency and tax status.)

UMH PTO Cash-In (To be completed in Workday. View tip sheet here.)
Check Replacement Request
Employee Override Authorization (Used by departments to authorize regular and/or overtime charges to an override account.)
Pay Stub Duplicate Request (To be used for replacing lost payroll checks.) Payment Elections (To be completed in Workday. View tip sheet here.)

Telecommuting Program

Telecommuting Program

Volunteer at UM

Volunteer Form
This form is to be completed by persons who wish to provide volunteer services to the University. Please visit the Volunteer Program page for more information.

Workplace Equity

Influenza Vaccination Request for Religious Exemption
Nursing Mother Accommodation Request
PAS-35 (Recruitment Activity Summary Form for Faculty)
This form provides adequate documentation of the University's good faith search efforts to achieve its affirmative action goals. The data provided are recorded and retrieved for EEO reporting. A faculty candidate shall not be offered the position until posting requirements are met and Workplace Equity and Performance verifies the search has met the EEO Guidelines.