Forms

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Title Documents & Links Revision Date
1000 FR.01 Policy Proposal PDF icon 1000 FR.01 Policy Proposal January 12, 2018
1001 FR.01 Request for Provostial Pre-Approval for Faculty Extra Compensation PDF icon 1001 FR.01 Request for Provostial Pre-Approval for Faculty Extra Compensation
PDF icon 1001 FR.01 Instructions - Request for Provostial Pre-Approval for Faculty Extra Compensation
March 29, 2018
1101 FR.01 Financial Review Checklist File 1101 FR.01 Financial Review Checklist February 16, 2021
1101 FR.02 Manual Journal Entry Request PDF icon 1101 FR.02 Manual Journal Entry Request June 20, 2017
1107 FR.01 Reporting Template for Foreign Gifts and Contracts File 1107 FR.01 Reporting Template for Foreign Gifts and Contracts October 27, 2020
1110 FR.01 Personal Use of University Vehicles - Department Summary Sheet PDF icon 1110FR.01 Personal Use of University Vehicles - Department Summary Sheet .pdf
Office spreadsheet icon 1110FR.01 Personal Use of University Vehicles - Department Summary Sheet .xls
November 11, 2015
1110 FR.02 Personal Use of University Vehicles - Questionnaire PDF icon 1110FR.02 Personal Use of University Vehicles - Questionnaire .pdf
Office spreadsheet icon 1110FR.02 Personal Use of University Vehicles - Questionnaire .xls
November 11, 2015
1110 FR.03 Mileage Record File 1110 FR.03 Mileage Record January 15, 2021
1300 FR.01 COA - Yale Designated Forms 1300 FR.01 COA - Yale Designated Forms May 22, 2017
1300 FR.02 COA - Cost Center Forms 1300 FR.02 COA - Cost Center Forms May 22, 2017
1300 FR.03 COA - Program Forms 1300 FR.03 COA - Program Forms May 22, 2017
1300 FR.04 COA - Project Forms 1300 FR.04 COA - Project Forms May 22, 2017
1300 FR.05 COA - Assignee Forms 1300 FR.05 COA - Assignee Forms May 22, 2017
1301 FR.01 Request to Transfer Residual Balance from Sponsored Awards PDF icon 1301 FR.01 Request to Transfer Residual Balance from Sponsored Awards October 25, 2017
1304 FR.01 Pre-Award Costs and At-Risk Account Request Form PDF icon 1304 FR.01 Pre-Award Costs and At-Risk Account Request Form
PDF icon 1304 FR.01 Pre-Award Costs and At-Risk Account Request Form - Instructions
March 10, 2021
1304 FR.03 Transmittal Summary (Tran Sum) Form File 1304 FR.03 Transmittal Summary (Tran Sum) Form April 9, 2020
1304 FR.03A Subrecipient Information and Compliance Form PDF icon 1304 FR.03A Subrecipient Information and Compliance Form May 6, 2020
1304 FR.03C National Research Service Award ("NRSA") Assurance of Compliance PDF icon 1304 FR.03C National Research Service Award ("NRSA") Assurance of Compliance February 28, 2020
1304 FR.04 Award Budget Setup ("ABS") Form File 1304 FR.04 Award Budget Setup ("ABS") Form
PDF icon 1304 FR.04 Award Budget Setup ("ABS") Form - Upload Instructions
April 27, 2020
1304 FR.06 Responsible Personnel Change Form PDF icon 1304 FR.06 Responsible Personnel Change Form June 8, 2017
1304 FR.09 Cost Allocation Methodology PDF icon 1304 FR.09 Cost Allocation Methodology
PDF icon 1304 FR.09 Cost Allocation Methodology - Instructions
January 14, 2021
1305 FR.15 Manual Journal-Cost Transfer Justification PDF icon 1305 FR.15 Manual Journal - Cost Transfer Justification March 5, 2019
1305 FR.17 GSPS Cost Transfer PDF icon 1305 FR.17 GSPS Cost Transfer March 5, 2019
1306 FR.01 Cost Sharing Approval Request PDF icon 1306 FR.01 Cost Sharing Approval Request
PDF icon 1306 FR.01 Cost Sharing Approval Request - Instructions
April 4, 2018
1307 FR.01 Request for Subrecipient Prepayment PDF icon 1307 FR.01 Request for Subrecipient Prepayment May 4, 2018
1310 FR.04 PI Status Request Form PDF icon 1310 FR.04 PI Status Request
PDF icon 1310 FR.04 PI Status Request - Instructions
June 28, 2018
1310 FR.05 Delegation of Requestor Authority for Sponsored Projects PDF icon 1310 FR.05 Delegation of Requestor Authority for Sponsored Projects February 27, 2019
1310 FR.06 Delegation of Approval Authority for Sponsored Projects PDF icon 1310 FR.06 Delegation of Approval Authority for Sponsored Projects May 4, 2018
1315 FR.01 Effort Report PDF icon 1315 FR.01A Effort Report - Short Form (8 Grants or Fewer)
PDF icon 1315 FR.01B Effort Report - Long Form (9 Grants or More)
PDF icon 1315 FR.01 Effort Report - Instructions
March 11, 2020
1403 FR.02 Justification to Direct Charge F&A Type Costs to a Federal Award PDF icon 1403 FR.02 Justification to Direct Charge F&A Type Costs to a Federal Award October 15, 2019
1410 FR.01 University Service Providers: Registration Form PDF icon 1410 FR.01 University Service Providers: Registration Form June 8, 2020
1410 FR.02 University Service Providers: Rate Calculation Worksheet File 1410 FR.02 University Service Providers: Rate Calculation Worksheet - USE FOR FY22
File 1410 FR.02 University Service Providers: Rate Calculation Worksheet - USE FOR FY21
PDF icon 1410 FR.02A Lead Administrator Certification Page
March 4, 2021
1410 FR.04 Lockshop Key Request PDF icon 1410 FR.04 Lockshop Key Request June 20, 2017
1411 FR.01 Memorandum of Understanding Office spreadsheet icon 1411 FR.01 Memorandum of Understanding.xls February 26, 2016
1430 FR.01 Shipping Policy Exception Request Form PDF icon 1430 FR.01 Shipping Policy Exception Request Form January 14, 2020
1601 FR.01 VPN Access Exception Request VPN Access Exception Request Link July 27, 2018
1601 FR.02 Identity and Access Management (IAM) PDF icon 1601 FR.02 Identity and Access Management (IAM) - Appendix A: Data Groupings
PDF icon 1601 FR.02 Identity and Access Management (IAM) - Appendix B: Affiliations and Suppression Rules
PDF icon 1601 FR.02 Identity and Access Management (IAM)
September 4, 2020
1601 FR.05 Workday Matrix Organization Creation PDF icon 1601 FR.05 Workday Matrix Organization Creation Request Form May 15, 2017
1601 FR.06 Workday Supervisory Organization Creation PDF icon 1601 FR.06 Workday Supervisory Organization Creation Request Form June 22, 2017
1601 FR.07 Workday Supervisory Organization Change PDF icon 1601 FR.07 Workday Supervisory Organization Change Request Form June 22, 2017
1601 FR.08 Workday Reorganization Request PDF icon 1601 FR.08 Workday Reorganization Request Form May 15, 2017
1800 FR.01 Yale Central Space Request PDF icon 1800 FR.01 Yale Central Space Request August 28, 2018
1800 FR.02 Yale Medicine Clinical Space Request PDF icon 1800 FR.02 Yale Medicine Clinical Space Request August 28, 2018
1800 FR.03 Yale School of Medicine Research/Administrative Space Request PDF icon 1800 FR.03 Yale School of Medicine Research/Administrative Space Request October 1, 2018
1800 FR.04 Yale Residential Rental Request PDF icon 1800 FR.04 Yale Residential Rental Request May 4, 2018
2015 Form 1040A Example A PDF icon 2015 Form 1040A Ex A
2015 Form 1040A Example B PDF icon 2015 Form 1040A Ex B.pdf
2015 Form 1040A Example C PDF icon 2015 Form 1040A Ex C.pdf
2015 Form 1040A Example D PDF icon 2015 Form 1040A Ex D.pdf
2015 Form 1040A Example E PDF icon 2015 Form 1040A Ex E.pdf
2015 Form 1040A Example F PDF icon 2015 Form 1040A Ex F.pdf
2015 Form CT-1040 Example A PDF icon 2015 Form CT-1040 EX A.pdf
2015 Form CT-1040 Example B PDF icon 2015 Form CT-1040 Ex B.pdf
2015 Form CT-1040 Example C PDF icon 2015 Form CT-1040 Ex C.pdf
2015 Form CT-1040 Example D PDF icon 2015 Form CT-1040 Ex D.pdf
2015 Form CT-1040 Example E PDF icon 2015 Form CT-1040 Ex E.pdf
2015 Form CT-1040 Example F PDF icon 2015 Form CT-1040 Ex F.pdf
2016 Form 1040ES Example A PDF icon 2016 Form 1040ES Ex A.pdf
2016 Form 1040ES Example B PDF icon 2016 Form 1040ES Ex B.pdf
2016 Form 1040ES Example C PDF icon 2016 Form 1040ES Ex C.pdf
2016 Form 1040ES Example D PDF icon 2016 Form 1040ES Ex D.pdf
2016 Form 1040ES Example E PDF icon 2016 Form 1040ES Ex E.pdf
2016 Form 1040ES Example F PDF icon 2016 Form 1040ES Ex F.pdf
2016 Form CT-1040ES Example A PDF icon 2016 Form CT-1040ES Ex A.pdf
2016 Form CT-1040ES Example B PDF icon 2016_form_ct-1040es_ex_b.pdf
2016 Form CT-1040ES Example C PDF icon 2016 Form CT-1040ES Ex C.pdf
2016 Form CT-1040ES Example D PDF icon 2016 Form CT-1040ES Ex D.pdf
2016 Form CT-1040ES Example E PDF icon 2016 Form CT-1040ES Ex E.pdf
2016 Form CT-1040ES Example F PDF icon 2016 Form CT-1040ES Ex F.pdf
2100 FR.01 External Sales Approval Request - Short Form File 2100 FR.01 External Sales Approval Request - Short Form January 9, 2019
2100 FR.02 External Sales Approval Request - Standard Form File 2100 FR.02 External Sales Approval Request - Standard Form January 9, 2019
2100 FR.03 External Sales Annual Reapproval Form File 2100 FR.03 External Sales Annual Reapproval Form January 9, 2019
2100 FR.04 External Sales Compliance Checklist PDF icon 2100 FR.04 External Sales Compliance Checklist January 9, 2019
2200 FR.01 Donee Information Return (IRS Form 8282) 2200 FR.01 Donee Information Return (IRS Form 8282) April 26, 2017
2200 FR.02 Noncash Charitable Contributions (IRS Form 8283) 2200 FR.02 Noncash Charitable Contributions (IRS Form 8283) April 26, 2017
2203 FR.03 Request to Reinvest Unspent Endowment Income to Principal PDF icon 2203 FR.03 Request to Reinvest Unspent Endowment Income to Principal September 29, 2020
2203 FR.04 Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE) PDF icon 2203 FR.04 Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE) September 29, 2020
2203 FR.05 Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE) PDF icon 2203 FR.05 Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE) July 17, 2019
2203 FR.06 Request to Close Spendable Gift PDF icon 2203 FR.06 Request to Close Spendable Gift November 5, 2019
2203 FR.07 YSM - Request to Reinvest Unspent Endowment Income to Principal PDF icon 2203 FR.07 YSM - Request to Reinvest Unspent Endowment Income to Principal September 29, 2020
2203 FR.08 YSM - Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE) PDF icon 2203 FR.08 YSM - Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE) November 5, 2019
2203 FR.09 YSM - Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE) PDF icon 2203 FR.09 YSM - Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE) November 5, 2019
2203 FR.10 Request to Set Up a New Gift 2203 FR.10 Request to Set Up a New Gift July 2, 2017
2801 FR.02 Money Transfer Form PDF icon 2801 FR.02 Money Transfer Form June 22, 2017
2805 FR.01 Cash Sale Worksheet PDF icon 2805 FR.01 Cash Sale Worksheet June 22, 2017
2810 FR.01 Sales Tax Report PDF icon 2810 FR.01 Sales Tax Report November 8, 2019
2815 FR.01 Petty Cash Voucher PDF icon 2815 FR.01 Petty Cash Voucher **[TCN]** June 22, 2017
2815 FR.02 Petty Cash Quick Voucher PDF icon 2815 FR.02 Petty Cash Quick Voucher **[TCN]** June 22, 2017
2815 FR.03 Petty Cash Fund Request PDF icon 2815 FR.03 Petty Cash Fund Request
PDF icon 2815 FR.03 Petty Cash Fund Request - Instructions
June 22, 2017
2815 FR.04 Petty Cash Replenishment PDF icon 2815 FR.04 Petty Cash Replenishment Form
PDF icon 2815 FR.04 Petty Cash Replenishment Form - Instructions **[TCN]**
June 22, 2017
3201 FR.04 Independent Cost Estimate PDF icon 3201 FR.04 Independent Cost Estimate October 2, 2020
3201 FR.05 Pricing Documentation (Comparative Pricing & Competitive Bidding) PDF icon 3201 FR.05 Pricing Documentation (Comparative Pricing & Competitive Bidding) July 29, 2019
3201 FR.06 Sole Source Documentation PDF icon 3201 FR.06 Sole Source Documentation July 29, 2019
3205 FR.04 Application for IRS Individual Taxpayer Identification Number (IRS Form W-7) 3205 FR.04 (IRS Form W-7) Application for IRS Individual Taxpayer Identification Number May 31, 2017
3205 FR.05 Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)(IRS Form W-8BEN) 3205 FR.05 (IRS Form W-8BEN) Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (Individual) May 31, 2017
3205 FR.05A Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)(IRS Form W-8BEN-E) 3205 FR.05A (IRS Form W-8BEN-E) Certificate of Status of Beneficial Owner for United States Tax Withholding (Entities) May 31, 2017
3205 FR.06 Request for Taxpayer Identification Number and Certification (IRS Form W-9) 3205 FR.06 (IRS Form W-9) Request for Taxpayer Identification Number and Certification May 31, 2017
3205 FR.07 Application for a Social Security Card (SSA Form SS-5) 3205 FR.07 (SSA Form SS-5) Application for a Social Security Card May 31, 2017
3205 FR.09 Supplier Change Request PDF icon 3205 FR.09 Supplier Change Request July 1, 2020
3210 FR.01 Professional Services and Consulting Agreement PDF icon 3210 FR.01 Professional Services and Consulting Agreement June 14, 2018
3210 FR.02 Guest Speaker Agreement PDF icon 3210 FR.02 Guest Speaker Agreement December 21, 2020
3210 FR.04 Standard Performance Agreement File 3210 FR.04 Standard Performance Agreement September 23, 2020
3210 FR.05 Professional Services and Consulting Agreement (PSCA): Exhibit A - Scope of Work (Services, Milestones, and Deliverables) PDF icon 3210 FR.05 PSCA Exhibit A - Scope of Work October 23, 2017
3210 FR.09 Yale University Music Commission Agreement PDF icon 3210 FR.09 Yale University Music Commission Agreement January 12, 2021
3215 FR.01 Yale Purchasing Card Cardholder Agreement PDF icon 3215 FR.01 Yale University Purchasing Card Cardholder Agreement May 2, 2019
3215 FR.03 Purchasing Card Application for Reactivation of Individual Card PDF icon 3215 FR.03 Purchasing Card Application for Reactivation of Individual Card July 1, 2017
3215 FR.06 Purchasing Card Request Form PDF icon 3215 FR.06 Purchasing Card Request Form September 11, 2019
3215 FR.07 Request to Delegate Authority to Prepare Expense Reports and Spend Authorizations PDF icon 3215 FR.07 Request to Delegate Authority to Prepare Expense Reports and Spend Authorizations July 13, 2017
3215 FR.09 120-366 Day Taxable Expense Reimbursement PDF icon 3215 FR.09 120-366 Day Taxable Expense Reimbursement April 6, 2018
3215 FR.10 Individual & Department PCard Exceptions PDF icon 3215 FR.10 Individual and Department PCard Exceptions July 13, 2017
3220 FR.02 Application for Controlled Substance Laboratory License - State of CT PDF icon 3220 FR.02 Application for Controlled Substance Laboratory License - State of CT June 20, 2017
3220 FR.04 COA Approval for State DCD Controlled Substance License PDF icon 3220 FR.04 COA Approval for State DCD Controlled Substance License June 20, 2017
3301 FR.04 Request for Travel Grant PDF icon 3301 FR.04 Request for Travel Grant.pdf
File 3301 FR.04 Request for Travel Grant.xlsx
March 3, 2016
3301 FR.05 Missing Receipts Form PDF icon 3301 FR.05 Missing Receipts Form March 29, 2018
3301 FR.06 Documentation for Travel on a Non-U.S. Air Carrier PDF icon 3301 FR.06 Documentation for Travel on a Non-U.S. Air Carrier January 13, 2021
3401 FR.01 Supplier Payment Setup: Wire Transfer PDF icon 3401 FR.01 Supplier Payment Setup: Wire Transfer September 15, 2020
3401 FR.02 Supplier Payment Setup: ACH/EFT PDF icon 3401 FR.02 Supplier Payment Setup: ACH/EFT June 30, 2020
3401 FR.03 Supplier Contact Information Form PDF icon 3401 FR.03 Supplier Contact Information Form January 11, 2021
3401 FR.04 Centralized Billing Account Maintenance PDF icon 3401 FR.04 Centralized Billing Account Maintenance November 26, 2018
3401 FR.06 Invoice Cover Sheet for International Activities PDF icon 3401 FR.06 Invoice Cover Sheet for International Activities July 1, 2017
3410 FR.01 Athlete or Entertainer Request for Reduced Withholding (Form CT-588) 3410 FR.01 (Form CT-588) Athlete or Entertainer Request for Reduced Withholding August 7, 2017
3410 FR.02 Athlete or Entertainer Request for Waiver of Withholding (Form CT-590) 3410 FR.02 (Form CT-590) Athlete or Entertainer Request for Waiver of Withholding August 7, 2017
3415 FR.01 International Information Form (IIF) for International Short-Term Visitors & Scholars PDF icon 3415 FR.01 International Information Form (IIF) Form for International Short-Term Visitors & Scholars - Form & Instructions February 18, 2020
3415 FR.02 Exemption From Withholding on Compensation for Independent (and Certain Dependent) Personal Services of a Nonresident Alien Individual (IRS Form 8233) 3415 FR.02 (IRS Form 8233) Exemption From Withholding on Compensation for Independent (and Certain Dependent) Personal Services August 4, 2017
3415 FR.04 Statement of Foreign Source Payments PDF icon Statement of Foreign Source Payments January 8, 2019
3501 FR.01 Payroll Costing Allocation Form File 3501 FR.01 Payroll Costing Allocation Form June 20, 2017
3501 FR.02 CT/MP Paid Time Off Adjustment Form PDF icon 3501 FR.02 CT/MP Paid Time Off Adjustment Form October 23, 2017
3501 FR.03 Payroll Accounting Adjustment Form File 3501 FR.03 Payroll Accounting Adjustment Form June 20, 2017
3501 FR.04 Direct Deposit Request PDF icon 3501 FR.04 Direct Deposit Request October 20, 2017
3501 FR.05 Direct Deposit Pull Authorization PDF icon 3501 FR.05 Direct Deposit Pull Authorization October 20, 2017
3501 FR.06 Overpayment Recovery Form PDF icon 3501 FR.06 Overpayment Recovery Form February 13, 2020
3501 FR.07 Payroll Payment Adjustment Form PDF icon 3501 FR.07 Payroll Payment Adjustment Form September 9, 2020
3501 FR.08 Stop Payment & Re-Issue Request PDF icon 3501 FR.08 Stop Payment & Re-Issue Request December 6, 2019
3501 FR.09 Vacation or Salary Advance Request Form PDF icon 3501 FR.09 Vacation or Salary Advance Request Form January 27, 2020
3501 FR.10 Faculty Request for Moving Allowance PDF icon 3501 FR.10 Faculty Request for Moving Allowance.pdf
File 3501 FR.10 Faculty Request for Moving Allowance.xlsx
March 2, 2016
3501 FR.11 Gift to Yale - Payroll Deduction Request PDF icon 3501 FR.11 Gift to Yale - Payroll Deduction Request November 2, 2017
3501 FR.14 Payroll Deduction Request for Personal PCard Transactions of Separating Employee PDF icon 3501 FR.14 Payroll Deduction Request for Personal PCard Transactions of Separating Employee January 10, 2019
3501 FR.17 Position Review -- Medical School only PDF icon 3501 FR.17 Position Review -- Medical School only.pdf
Office spreadsheet icon 3501 FR.17 Position Review -- Medical School only.xls
August 27, 2004
3501 FR.51 Application for Faculty Child Care Grant PDF icon 3501 FR.51 Application for Faculty Child Care Grant September 16, 2019
3501 FR.55 Application for M&P Sabbatical Office spreadsheet icon 3501 FR.55 Application for M&P Sabbatical.xls April 2, 2014
3502 FR.01 Temporary Employee Payment Request PDF icon 3502 FR.01 Temporary Employee Payment Request October 25, 2017
3503 FR.01 Onboarding a New Employee Checklist PDF icon 3503 FR.01 Onboarding a New Employee Checklist April 8, 2020
3503 FR.02 Promotion & Transfer Checklist PDF icon 3503 FR.02 Promotion & Transfer Checklist March 16, 2018
3503 FR.03 Termination Checklist Binary Data April 7, 2021
3503 FR.24 Professional Student Payment Setup and Job Change Form PDF icon 3503 FR.24 Professional Student Payment Setup and Job Change Form September 19, 2017
3503 FR.25 Professional School Student Payment Form PDF icon 3503 FR.25 Professional School Student Payment Form August 17, 2017
3505 FR.01 Out-of-State (U.S.) Hiring & Placement Questionnaire PDF icon 3505 FR.01 Out-of-State (U.S.) Hiring & Placement Questionnaire February 1, 2019
3505 FR.02 Out-of-State (International) Hiring & Placement Questionnaire PDF icon 3505 FR.02 Out-of-State (International) Hiring & Placement Questionnaire June 22, 2020
3510 FR.01 Relocation Reimbursement Request PDF icon 3510 FR.01 Relocation Reimbursement Request January 2, 2020
403(b) Deferral at Termination or Retirement form PDF icon 403b-deferral-at-termination-or-retirement_2016.pdf
4209 FR.04 Request for Capitalization of MEI Composite Assets and Accessories PDF icon 4209 FR.04 Request for Capitalization of MEI Composite Assets and Accessories May 18, 2017
4209 FR.05 Capital Equipment Transfer Release Form PDF icon 4209 FR.05 Capital Equipment Transfer Release Form June 1, 2017
500 FR 1 Financial and Non Financial Interests in Human Research Disclosure: Yale IRB Members and Staff Microsoft Office document icon 500 FR.1 Financial and Non Financial Interests in Human Research Disclosure: Yale IRB Members and Staff August 24, 2012
Adoption Reimbursement Claim Form File Adoption Reimbursement Claim Form
Aetna Medical Claim Form PDF icon Aetna Medical Claim - form
Aetna Prescription Home Delivery Order Form Aetna Prescription Home Delivery Order Form
ALICE Request Form File ALICE Request Form July 8, 2013
Application For Permission To Have Custom Antibodies Manufactured Microsoft Office document icon Application For Permission To Have Custom Antibodies Manufactured December 1, 2010
Authorization for Relocation Allowance
Benefits Revision Request form PDF icon benefits_revision-request.pdf
C&T Performance Feedback Resources PDF icon C&T Performance Feedback form
PDF icon Instructions for completing the C&T Performance Feedback form
PDF icon Sample C&T Performance Feedback form
File SMART Goal Setting Guide Video: Performance Feedback for Clerical and Technical Employees
Carryover Report FY16 - Supervisor version Office spreadsheet icon carryoverreport-supervisor.xls
Child Assent Form Microsoft Office document icon Child Assent Form February 15, 2017
Child Scholarship Plan for the Faculty and Staff of Yale University (Online Application) Child Scholarship Application
Clerical and Technical Job Audit Forms PDF icon Job Audit Timeline
Microsoft Office document icon Job Audit Form for Grade B, C & D Upgrades
Microsoft Office document icon Job Audit Form for a Grade E Upgrade
College Savings 529 - forms PDF icon College Savings 529 (CHET) Payroll Direct Deposit College Savings 529 (CHET) Application January 29, 2021
Conflict of Interest Travel Form PDF icon Conflict of Interest Travel Form
CT Administrative Regulations PDF icon CT Administrative Regulations
CT Paid Sick Leave Act PDF icon CT Paid Sick Leave Act
CT Paid Sick Leave Act (Spanish) PDF icon CT Paid Sick Leave Act (Spanish)
Delta Dental Claim Form PDF icon Delta Dental Claim Form
Dental PDF icon Delta Dental Care Plan (Non-Union)
PDF icon Delta Dental Care Plan (Union)
PDF icon 2015 CIGNA Dental Care Plan
Discrimination is Illegal PDF icon Discrimination is Illegal
Draft Summary Revision Template Microsoft Office document icon Draft Summary Revision Template September 7, 2005
Electronic Monitoring PDF icon Electronic Monitoring
Employee Polygraph Protection Act PDF icon Employee Polygraph Protection Act
Employee Rights under the NLRA PDF icon Employee Rights under the NLRA
Equal Employment Opportunity PDF icon Equal Employment Opportunity
External Revenue Form Office spreadsheet icon External Revenue Form
EyeMed Vision Claim Form PDF icon EyeMed Vision Claim Form
Facilities Work Request Facilities Work Request Link December 18, 2013
Family Medical Leave Act (FMLA) PDF icon Family Medical Leave Act (FMLA)
Federal Minimum Wage Law PDF icon Federal Minimum Wage Law
Flexible Spending Account (FSA) - forms PDF icon Statement of Medical Necessity (SOMN) - FSA
PDF icon Tuition Assistance (Employee) - FSA
PDF icon Health Care Claim Form-FSA
PDF icon Dependent/Child Care Reimbursement Claim Form
Flexible Spending Accounts (FSA) - Reimbursement Plan PDF icon Healthcare/Dental Reimbursement Plan
PDF icon Dependent Care Reimbursement Plan
Flexible Work Arrangement (FWA) Manager Log File fwa_manager_log.xlsx
FLSA Forms and Documents File FLSA Questionnaire
FMLA Revised Regulations PDF icon FMLA Revised Regulations
Form I-20 Sample Image icon I-20 Sample
Form SSA-7028 - Sample (Notice to third party of SSN assignments) PDF icon Form SSA-7028 Sample.pdf
Form T-200 PDF icon Form-T-200.pdf
Form T-400, CERTIFICATE OF LOCATION OF PROFESSIONAL SERVICES PDF icon Form T-400 CERTIFICATE OF LOCATION OF PROFESSIONAL SERVICES October 1, 2016
Form Template Microsoft Office document icon Form Template September 5, 2007
Genetic Information Nondiscrimination Act of 2008 PDF icon Genetic Information Nondiscrimination Act of 2008
Group Accident Insurance PDF icon Colonial Group Accident Certificate
Guide Template Microsoft Office document icon Guide Template October 17, 2006
Human Participants Human Research Forms & Templates September 12, 2013
IRS Form 8300 PDF icon f8300.pdf
PDF icon Form 8300 Sample
Lead Administrator Feedback on Change Partner Network File Lead Administrator Feedback on Change Partner Network
Life Insurance - Forms PDF icon GROUP LIFE INSURANCE POLICY
PDF icon GROUP POLICY AMENDMENT NO. 1
PDF icon GROUP POLICY AMENDMENT NO. 2
PDF icon GROUP POLICY AMENDMENT NO. 3
PDF icon GROUP POLICY AMENDMENT NO. 16
PDF icon NOTICE OF PLAN CHANGE
PDF icon Schedule of Insurance
PDF icon Group Policy Amendment NO. 4
PDF icon CERTIFICATE AND SUMMARY PLAN DESCRIPTION GROUP LIFE INSURANCE
Life Insurance - forms PDF icon Absolute Assignment FORM
Local 35 Training Form Microsoft Office document icon local-35-training-form.doc
Long-Term Care Monumental Plan
Long-Term Disability (LTD) Telephone Filing Instructions PDF icon Long Term Disability (STD) Telephone Filing Instructions April 10, 2019
Long-Term Disability - Standard - Forms PDF icon Post Doctoral Associates and Faculty Members no YURAP
PDF icon Faculty, M&P Certificate
PDF icon Medical School Faculty Certificate
PDF icon Non-exempt Members Not Represented by YPBA Certificate
PDF icon M&P who does not participate in YURAP and Police Officers represented by YPBA Certificate
PDF icon Group Policy Amendment NO 17
M&P Job Evaluation Questionnaire File M&P Job Evaluation Questionnaire
M&P Performance Feedback Resources
Managed Care PDF icon Managed Care
Manager Checklist for New Employees
Medical - Aetna Plan Members (C&T and S&M) - forms PDF icon Benefit Plan – Aetna Select
PDF icon Schedule of Benefits – Aetna Select
PDF icon Aetna Select – (Non-CT Residence)
File Summary of Benefits & Coverage – AETNA Select
File AETNA Select (Non-CT Residence)
PDF icon Benefit Plan – Legacy Aetna Choice (Base Rx)
PDF icon Legacy AETNA Choice (Alt. Rx)
PDF icon Schedule of Benefits – Legacy AETNA Choice (Base Rx)
PDF icon Legacy AETNA Choice (Alt. Rx)
File Summary of Benefits & Coverage – Legacy AETNA Choice (Base Rx)
File Legacy AETNA Choice (Alt. Rx)
Medical - Aetna Plan Members (Faculty and M&P) PDF icon Benefit Plan - AETNA Smart Care W/ Optional Health Saving Account
PDF icon Schedule of Benefits - AETNA Smart Care W/ Optional Health Saving Account
File Summary of Benefits & Coverage (SBC) - AETNA Smart Care W/ Optional Health Savings Account
PDF icon Benefit Plan - AETNA Choice
PDF icon Schedule of Benefits - AETNA Choice
File Summary of Benefits & Coverage (SBC) - AETNA Choice
PDF icon Benefit Plan - Legacy Aetna Choice
PDF icon Schedule of Benefits - Legacy Aetna Choice
File Summary of Benefits & Coverage (SBC) - Legacy AETNA Choice
Medical - Aetna Plan Members (Security) PDF icon Benefit Plan - Aetna Select
PDF icon Schedule of Benefits - Aetna Select
PDF icon Schedule of Benefits - Aetna Select - (Non CT Residence)
File Summary of Benefits & Coverage (SBC) - AETNA Select
File Summary of Benefits & Coverage (SBC) (Non CT Residence) - AETNA Select
PDF icon Benefit Plan - Legacy Aetna Choice (Base Rx)
PDF icon Schedule of Benefits - Legacy Aetna Choice (Base Rx)
File Summary of Benefits & Coverage (SBC) - Legacy AETNA Choice
Medical - Aetna Plan Members (Yale Police Benevolent Association) PDF icon Benefit Plan - AETNA Smart Care W/Optional Health Savings Account
PDF icon Schedule of Benefits – AETNA Smart Care W/Optional Health Savings Account
File Summary of Benefits & Coverage – AETNA Smart Care W/Optional Health Savings Account
PDF icon Benefit Plan – AETNA Choice
PDF icon Schedule of Benefits – AETNA Choice
File Summary of Benefits & Coverage – AETNA Choice
PDF icon Benefit Plan – Legacy AETNA Choice (Base Rx)
PDF icon Legacy AETNA Choice (Alt. Rx)
PDF icon Schedule of Benefits – Legacy AETNA Choice (Base Rx)
PDF icon Legacy AETNA Choice (Alt. Rx)
File Summary of Benefits & Coverage – Legacy AETNA Choice (Base Rx)
File Legacy AETNA Choice (Alt. Rx)
Medical - YHP Members - forms Binary Data
Military FMLA Leave Amendment PDF icon Military FMLA Leave Amendment
Model COI (Conflict of Interest) Disclosure Form PDF icon Model COI (Conflict of Interest) Disclosure Form January 28, 2013
Model COI Form File ModelCOIform.docx
New P. O. Box Request
Notice of Policy Applicable to Individual w/ Disability, Protected Veterans PDF icon Notice of Policy Applicable to Individual w/ Disability, Protected Veterans
OSHA PDF icon OSHA
Parking and Transit Forms Parking August 15, 2013
Policy Template Microsoft Office document icon Policy Template August 17, 2006
Post-Award Partnership Agreement PDF icon Post-Award Partnership Agreement March 1, 2016
Pregnancy Discrimination and Accommodation in the Workplace PDF icon ss46a_pregnancy_disability_poster.pdf
Pregnancy Discrimination and Accommodation in the Workplace - Spanish PDF icon ss46a_pregnancy_disability_poster_spanish.pdf
Procedure Template Microsoft Office document icon Procedure Template August 17, 2006
Request for Service (RIS) Yale Printing & Publishing Services Link February 28, 2002
Research Performance Progress Report (RPPR) Checklist File Research Performance Progress Report (RPPR) Checklist
Sexual Harassment PDF icon Sexual Harassment
Short-Term Disability (STD) Telephone Filing Instructions PDF icon Short Term Disability (STD) Telephone Filing Instructions
Short-Term Disability - Forms PDF icon SHORT-TERM DISABILITY INCOME BENEFIT PLAN
Special Permission to Serve as PI Microsoft Office document icon Special Permission to Serve as PI February 15, 2017
Standard Life Insurance - Death Claim Form PDF icon Standard Life Insurance - Death Claim Form
Subaward Reconciliation Form File Subaward Reconciliation Form
Summary Annual Reports & Required Disclosures - Forms PDF icon 2014 Summary Annual Reports
PDF icon 2020 Notice of Creditable Coverage for Active Participants
PDF icon 2020 Notice of Creditable Coverage for Retired Participants
PDF icon Affordable Care Act Notice - Non-covered employees
PDF icon Affordable Care Act Notice - Covered employees
PDF icon Early Retiree Reinsurance Notice
PDF icon Medicaid and the Children’s Health Insurance Program (CHIP)
PDF icon Women’s Health Rights Under the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA)
PDF icon Women’s Health and Cancer Rights Act (WHCRA)
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