Forms

Note: Use the browser Print and Email (Send) functions under the File menu to print and share these documents.

Business Area

Topic Area

Title	Documents & Links	Revision Date
1000 FR.01 Policy Proposal	1000 FR.01 Policy Proposal	January 12, 2018
1001 FR.01 Request for Provostial Pre-Approval for Faculty Extra Compensation	1001 FR.01 Request for Provostial Pre-Approval for Faculty Extra Compensation 1001 FR.01 Instructions - Request for Provostial Pre-Approval for Faculty Extra Compensation	March 29, 2018
1101 FR.01 Financial Review Checklist	1101FR.01 Financial Review Checklist	July 16, 2018
1101 FR.02 Manual Journal Entry Request	1101 FR.02 Manual Journal Entry Request	June 20, 2017
1110 FR.01 Personal Use of University Vehicles - Department Summary Sheet	1110FR.01 Personal Use of University Vehicles - Department Summary Sheet .pdf 1110FR.01 Personal Use of University Vehicles - Department Summary Sheet .xls	November 11, 2015
1110 FR.02 Personal Use of University Vehicles - Questionnaire	1110FR.02 Personal Use of University Vehicles - Questionnaire .pdf 1110FR.02 Personal Use of University Vehicles - Questionnaire .xls	November 11, 2015
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	1301 FR.01 Request to Transfer Residual Balance from Sponsored Awards	October 25, 2017
1304 FR.01 At-Risk Account Request	1304 FR.01 At-Risk Account Request Form 1304 FR.01 At-Risk Account Request Instructions	January 4, 2017
1304 FR.03 Transmittal Summary (Tran Sum) Form	1304 FR.03 Transmittal Summary Form (TranSum) 1304 FR.03 Transmittal Summary Form - Instructions	June 21, 2018
1304 FR.03A Subrecipient Information and Compliance Form	1304 FR.03A Subrecipient Information and Compliance Form	August 2, 2018
1304 FR.03B-E Transmittal Summary (Tran Sum) Attachments	1304 FR.03 App B-E Transmittal Summary (Tran Sum) Attachments	December 11, 2012
1304 FR.06 Responsible Personnel Change Form	1304 FR.06 Responsible Personnel Change Form	June 8, 2017
1304 FR.09 Cost Allocation Methodology	1304 FR.09 Cost Allocation Methodology	June 15, 2017
1305 FR.15 Manual Journal-Cost Transfer Justification	1305 FR.15 Manual Journal - Cost Transfer Justification	June 29, 2017
1305 FR.17 GSPS Cost Transfer	1305 FR.17 GSPS Cost Transfer	June 27, 2017
1306 FR.01 Cost Sharing Approval Request	1306 FR.01 Cost Sharing Approval Request 1306 FR.01 Cost Sharing Approval Request - Instructions	April 4, 2018
1307 FR.01 Request for Subrecipient Prepayment	1307 FR.01 Request for Subrecipient Prepayment	May 4, 2018
1310 FR.04 PI Status Request Form	1310 FR.04 PI Status Request 1310 FR.04 PI Status Request - Instructions	June 28, 2018
1310 FR.05 Delegation of Requestor Authority for Sponsored Projects	1310 FR.05 Delegation of Requestor Authority for Sponsored Projects	June 28, 2017
1310 FR.06 Delegation of Approval Authority for Sponsored Projects	1310 FR.06 Delegation of Approval Authority for Sponsored Projects	May 4, 2018
1315 FR.01 Effort Report	1315 FR.01 Effort Report 1315 FR.01 Effort Report - Instructions	January 23, 2018
1403 FR.02 Justification to Direct Charge F&A Type Costs to a Federal Award	1403 FR.02 Justification to Direct Charge F&A Type Costs to a Federal Award	June 27, 2017
1410 FR.04 Lockshop Key Request	1410 FR.04 Lockshop Key Request	June 20, 2017
1410 FR.13 Internal Service Providers: Registration	1410FR.13 Internal Service Providers-Registration 1410FR.13 Instructions- Internal Service Provider	May 31, 2018
1410 FR.14 Internal Service Providers: Rate Calculation (Manual)	1410FR.14 Instructions - Internal Service Provider Rate Calculation (Manual) 1410FR.14 Internal Service Provider Rate Calculation (Manual)	May 31, 2018
1411 FR.01 Memorandum of Understanding	1411 FR.01 Memorandum of Understanding.xls	February 26, 2016
1430 FR.01 Shipping Policy Exception Request Form	1430 FR.01 Shipping Policy Exception Request Form	February 2, 2018
1601 FR.01 VPN Access Exception Request	VPN Access Exception Request Link	July 27, 2018
1601 FR.02 Identity and Access Management (IAM)	1601 FR.02 Identity and Access Management (IAM) 1601 FR.02 Identity and Access Management (IAM) - Appendix A: Data Groupings 1601 FR.02 Identity and Access Management (IAM) - Appendix B: Affiliations and Suppression Rules	March 8, 2018
1601 FR.05 Workday Matrix Organization Creation	1601 FR.05 Workday Matrix Organization Creation Request Form	May 15, 2017
1601 FR.06 Workday Supervisory Organization Creation	1601 FR.06 Workday Supervisory Organization Creation Request Form	June 22, 2017
1601 FR.07 Workday Supervisory Organization Change	1601 FR.07 Workday Supervisory Organization Change Request Form	June 22, 2017
1601 FR.08 Workday Reorganization Request	1601 FR.08 Workday Reorganization Request Form	May 15, 2017
1800 FR.01 Yale Central Space Request	1800 FR.01 Yale Central Space Request	May 4, 2018
1800 FR.02 Yale Medicine Clinical Space Request	1800 FR.02 Yale Medicine Clinical Space Request	May 4, 2018
1800 FR.03 Yale Medicine Research/Administrative Space Request	1800 FR.03 Yale Medicine Research/Administrative Space Request	May 4, 2018
1800 FR.04 Yale Residential Rental Request	1800 FR.04 Yale Residential Rental Request	May 4, 2018
200 FR .3 (2014-1) Short Form Consent Template Creole	Short Form Consent Template Creole	May 22, 2017
200 FR. 03 (2014-1)‎ Short Form Consent Template Urdu	Short Form Consent Template Urdu	June 29, 2017
2015 Form 1040A Example A	2015 Form 1040A Ex A
2015 Form 1040A Example B	2015 Form 1040A Ex B.pdf
2015 Form 1040A Example C	2015 Form 1040A Ex C.pdf
2015 Form 1040A Example D	2015 Form 1040A Ex D.pdf
2015 Form 1040A Example E	2015 Form 1040A Ex E.pdf
2015 Form 1040A Example F	2015 Form 1040A Ex F.pdf
2015 Form CT-1040 Example A	2015 Form CT-1040 EX A.pdf
2015 Form CT-1040 Example B	2015 Form CT-1040 Ex B.pdf
2015 Form CT-1040 Example C	2015 Form CT-1040 Ex C.pdf
2015 Form CT-1040 Example D	2015 Form CT-1040 Ex D.pdf
2015 Form CT-1040 Example E	2015 Form CT-1040 Ex E.pdf
2015 Form CT-1040 Example F	2015 Form CT-1040 Ex F.pdf
2016 Form 1040ES Example A	2016 Form 1040ES Ex A.pdf
2016 Form 1040ES Example B	2016 Form 1040ES Ex B.pdf
2016 Form 1040ES Example C	2016 Form 1040ES Ex C.pdf
2016 Form 1040ES Example D	2016 Form 1040ES Ex D.pdf
2016 Form 1040ES Example E	2016 Form 1040ES Ex E.pdf
2016 Form 1040ES Example F	2016 Form 1040ES Ex F.pdf
2016 Form CT-1040ES Example A	2016 Form CT-1040ES Ex A.pdf
2016 Form CT-1040ES Example B	2016_form_ct-1040es_ex_b.pdf
2016 Form CT-1040ES Example C	2016 Form CT-1040ES Ex C.pdf
2016 Form CT-1040ES Example D	2016 Form CT-1040ES Ex D.pdf
2016 Form CT-1040ES Example E	2016 Form CT-1040ES Ex E.pdf
2016 Form CT-1040ES Example F	2016 Form CT-1040ES Ex F.pdf
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	2203 FR.03 Request to Reinvest Unspent Endowment Income to Principal	June 2, 2017
2203 FR.04 Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE)	2203 FR.04 Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE)	August 1, 2018
2203 FR.05 Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE)	2203 FR.05 Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE)	August 1, 2018
2203 FR.06 Request to Close Spendable Gift	2203 FR.06 Request to Close Spendable Gift	June 2, 2017
2203 FR.07 YSM - Request to Reinvest Unspent Endowment Income to Principal	2203 FR.07 YSM - Request to Reinvest Unspent Endowment Income to Principal	June 2, 2017
2203 FR.08 YSM - Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE)	2203 FR.08 YSM - Request to Set-Up or Add to a University Fund Functioning as Endowment (UFFE)	August 1, 2018
2203 FR.09 YSM - Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE)	2203 FR.09 YSM - Request to Decapitalize an Existing University Fund Functioning as Endowment (UFFE)	August 1, 2018
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	2801 FR.02 Money Transfer Form	June 22, 2017
2805 FR.01 Cash Sale Worksheet	2805 FR.01 Cash Sale Worksheet	June 22, 2017
2810 FR.02 Sales Tax Report	2810 FR.02 Sales Tax Report	August 8, 2017
2815 FR.01 Petty Cash Voucher	2815 FR.01 Petty Cash Voucher [TCN]	June 22, 2017
2815 FR.02 Petty Cash Quick Voucher	2815 FR.02 Petty Cash Quick Voucher [TCN]	June 22, 2017
2815 FR.03 Petty Cash Fund Request	2815 FR.03 Petty Cash Fund Request 2815 FR.03 Petty Cash Fund Request - Instructions	June 22, 2017
2815 FR.04 Petty Cash Replenishment	2815 FR.04 Petty Cash Replenishment Form 2815 FR.04 Petty Cash Replenishment Form - Instructions [TCN]	June 22, 2017
2815 FR.05 Mileage Record	2815 FR.05 Mileage Record.pdf 2815 FR.05 Mileage Record.xls	November 1, 2011
3201 FR.01 Request for Proposal (RFP)	3201 FR.01 Request for Proposal (RFP)	July 1, 2017
3201 FR.02 Request for Quotations (RFQ)	3201 FR.02 Request for Quotations (RFQ)	July 1, 2017
3201 FR.03 Request for Information (RFI)	3201 FR.03 Request for Information (RFI)	July 1, 2017
3205 FR.03 Explanation for Sole Source Supplier	3205 FR.03 Explanation for Sole Source Supplier	July 1, 2017
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.08 ACH-EFT Supplier Enrollment Form	3205 FR.08 ACH-EFT Supplier Enrollment Form	July 1, 2017
3205 FR.09 Supplier Change Request	3205FR.09 Supplier Change Request	April 19, 2018
3210 FR.01 Professional Services and Consulting Agreement	3210 FR.01 Professional Services and Consulting Agreement	June 14, 2018
3210 FR.02 Guest Speaker Agreement	3210 FR.02 Guest Speaker Agreement	July 1, 2017
3210 FR.03 Professional Services and Consulting Certification Form	3210 FR.03 Professional Services and Consulting Certification	June 11, 2018
3210 FR.04 Standard Performance Agreement	3210 FR.04 Standard Performance Agreement	July 1, 2017
3210 FR.05 Professional Services and Consulting Agreement (PSCA): Exhibit A - Scope of Work (Services, Milestones, and Deliverables)	3210 FR.05 PSCA Exhibit A - Scope of Work	October 23, 2017
3215 FR.03 Purchasing Card Application for Reactivation of Individual Card	3215 FR.03 Purchasing Card Application for Reactivation of Individual Card	July 1, 2017
3215 FR.06 Purchasing Card Request Form	3215 FR.06 Purchasing Card Request Form	July 13, 2017
3215 FR.07 Request to Delegate Authority to Prepare Expense Reports and Spend Authorizations	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	3215 FR.09 120-366 Day Taxable Expense Reimbursement	April 6, 2018
3215 FR.10 Individual & Department PCard Exceptions	3215 FR.10 Individual and Department PCard Exceptions	July 13, 2017
3220 FR.01 Restricted Items Approval Request	3220 FR.01 Restricted Items Approval Request	June 20, 2017
3220 FR.02 Application for Controlled Substance Laboratory License - State of CT	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	3220 FR.04 COA Approval for State DCD Controlled Substance License	June 20, 2017
3301 FR.04 Request for Travel Grant	3301 FR.04 Request for Travel Grant.pdf 3301 FR.04 Request for Travel Grant.xlsx	March 3, 2016
3301 FR.05 Missing Receipts Form	3301 FR.05 Missing Receipts Form	March 29, 2018
3301 FR.06 Documentation for Travel on a Non-U.S. Air Carrier	3301 FR.06 Documentation for Travel on a Non-U.S. Air Carrier	August 1, 2018
3401 FR.01 Wire Payment Setup Form	3401 FR.01 Wire Payment Setup Form	January 18, 2018
3401 FR.04 Centralized Billing Account Maintenance	3401 FR.04 Centralized Billing Account Maintenance	January 18, 2018
3401 FR.06 Invoice Cover Sheet for International Activities	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)	3415 FR.01 International Information Form (IIF).pdf 3415 FR.01 International Information Form (IIF) - Instructions	October 26, 2009
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 T-100	3415 FR.04 T-100.pdf	July 1, 2000
3501 FR.01 Payroll Costing Allocation Form	3501 FR.01 Payroll Costing Allocation Form	June 20, 2017
3501 FR.02 CT/MP Paid Time Off Adjustment Form	3501 FR.02 CT/MP Paid Time Off Adjustment Form	October 23, 2017
3501 FR.03 Payroll Accounting Adjustment Form	3501 FR.03 Payroll Accounting Adjustment Form	June 20, 2017
3501 FR.04 Direct Deposit Request	3501 FR.04 Direct Deposit Request	October 20, 2017
3501 FR.05 Direct Deposit Pull Authorization	3501 FR.05 Direct Deposit Pull Authorization	October 20, 2017
3501 FR.06 Overpayment Recovery Form	3501 FR.06 Overpayment Recovery Form	January 3, 2018
3501 FR.07 Payroll Payment Adjustment Form	3501 FR.07 Payroll Payment Adjustment Form	June 25, 2018
3501 FR.08 Stop Payment & Re-Issue Request	3501 FR.08 Stop Payment & Re-Issue Request	March 16, 2018
3501 FR.09 Vacation or Salary Advance Request Form	3501 FR.09 Vacation or Salary Advance Request Form	October 20, 2017
3501 FR.10 Faculty Request for Moving Allowance	3501 FR.10 Faculty Request for Moving Allowance.pdf 3501 FR.10 Faculty Request for Moving Allowance.xlsx	March 2, 2016
3501 FR.11 Gift to Yale - Payroll Deduction Request	3501 FR.11 Gift to Yale - Payroll Deduction Request	November 2, 2017
3501 FR.17 Position Review -- Medical School only	3501 FR.17 Position Review -- Medical School only.pdf 3501 FR.17 Position Review -- Medical School only.xls	August 27, 2004
3501 FR.51 Application for Faculty Child Care Grant	3501fr_51_faculty_dependent_child_care.xlsx	September 27, 2016
3501 FR.55 Application for M&P Sabbatical	3501 FR.55 Application for M&P Sabbatical.xls	April 2, 2014
3502 FR.01 Temporary Employee Payment Request	3502 FR.01 Temporary Employee Payment Request	October 25, 2017
3503 FR.01 Onboarding a New Employee Checklist	3503 FR.01 Onboarding a New Employee Checklist	March 16, 2018
3503 FR.02 Promotion & Transfer Checklist	3503 FR.02 Promotion & Transfer Checklist	March 16, 2018
3503 FR.03 Termination Checklist	3503 FR.03 Termination Checklist	February 27, 2018
3503 FR.24 Professional Student Payment Setup and Job Change Form	3503 FR.24 Professional Student Payment Setup and Job Change Form	September 19, 2017
3503 FR.25 Professional School Student Payment Form	3503 FR.25 Professional School Student Payment Form	August 17, 2017
3505 FR.01 Out-of-State (U.S.) Hiring & Placement Questionnaire	3505 FR.01 Out-of-State (U.S.) Hiring & Placement Questionnaire	August 3, 2018
3505 FR.02 Out-of-State (International) Hiring & Placement Questionnaire	3505 FR.02 Out-of-State (International) Hiring & Placement Questionnaire	August 3, 2018
3510 FR.01 Relocation Reimbursement Request	3510 FR.01 Relocation Reimbursement Request	May 9, 2018
403(b) Deferral at Termination or Retirement form	403b-deferral-at-termination-or-retirement_2016.pdf
4209 FR.04 Request for Capitalization of MEI Composite Assets and Accessories	4209 FR.04 Request for Capitalization of MEI Composite Assets and Accessories	May 18, 2017
4209 FR.05 Capital Equipment Transfer Release Form	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	500 FR.1 Financial and Non Financial Interests in Human Research Disclosure: Yale IRB Members and Staff	August 24, 2012
Adoption Reimbursement Claim Form	Adoption Reimbursement Claim Form
Aetna Medical Claim - form	Aetna Medical Claim - form
Aetna Plan Amendments	Aetna Amendment: High-Deductible w/Health Savings Account (M&P and Faculty) Aetna Amendment: HSA Routine Physical (M&P and Faculty) Aetna Amendment: Routine Physicals (C&T and S&M) / (YPBA) Aetna Amendment: Prescription Plan (C&T and S&M) Aetna Amendment: Prescription Supply (C&T and S&M)
Aetna Prescription Home Delivery Order Form	Aetna Prescription Home Delivery Order Form
Affirmative Action	Affirmative Action (DOC)
ALICE Request Form	ALICE Request Form	July 8, 2013
Application For Permission To Have Custom Antibodies Manufactured	Application For Permission To Have Custom Antibodies Manufactured	December 1, 2010
Application to Park for Employees w/Disabilities	parking_privileges_form_updated_03_27_11.pdf	April 25, 2016
Authorization for Relocation Allowance
Benefits Revision Request form	benefits_revision-request.pdf
C&T Performance Feedback Resources	C&T Performance Feedback form Instructions for completing the C&T Performance Feedback form Sample C&T Performance Feedback form Tips for setting SMART goals Performance Management guide
Cancellation of Fee Parking
Carryover Report FY16 - Supervisor version	carryoverreport-supervisor.xls
Certification of Family Member’s Serious Health Condition form	3501_fr.50a_-_certification_of_family_members_serious_health_condition.pdf
Certification of Serious Health Condition form	Certification of Serious Health Condition form
Child Assent Form	Child Assent Form	February 15, 2017
Child Scholarship Plan for the Faculty and Staff of Yale University	Child Scholarship Plan for the Faculty and Staff of Yale University	December 7, 2017
Child Scholarship Plan for the Faculty and Staff of Yale University (Online Application)	Child Scholarship Application
Clerical and Technical Job Audit Forms	Job Audit Timeline Job Audit Form for Grade B, C & D Upgrades Job Audit Form for a Grade E Upgrade
College Savings 529 - forms	College Savings 529 (CHET) Payroll Authorization College Savings 529 (CHET) Application
Conflict of Interest Travel Form	Conflict of Interest Travel Form
Courier Service Request
CT Administrative Regulations	CT Administrative Regulations
CT Paid Sick Leave Act	CT Paid Sick Leave Act
CT Paid Sick Leave Act (Spanish)	CT Paid Sick Leave Act (Spanish)
Delta Dental Claim Form	Delta Dental Claim Form
Dental	2016 Delta Dental Care Plan - M&P and Faculty 2016 Delta Dental Care Plan - C&T, S&M, YPBA and Security 2015 CIGNA Dental Care Plan
Department Relocations
Discrimination is Illegal	Discrimination is Illegal
Draft Summary Revision Template	Draft Summary Revision Template	September 7, 2005
Electronic Monitoring	Electronic Monitoring
Employee Polygraph Protection Act	Employee Polygraph Protection Act
Employee Rights under the NLRA	Employee Rights under the NLRA
Equal Employment Opportunity	Equal Employment Opportunity
External Revenue Form	External Revenue Form
EyeMed Vision Claim Form	EyeMed Vision Claim Form
Facilities Work Request	Facilities Work Request Link	December 18, 2013
Family Medical Leave Act (FMLA)	Family Medical Leave Act (FMLA)
Federal Minimum Wage Law	Federal Minimum Wage Law
Flexible Spending Account (FSA) - forms	Medical/Dental Reimbursement Claim Form - FSA Statement of Medical Necessity (SOMN) - FSA Dependent/Child Care Reimbursement Claim Form - FSA Tuition Assistance (Employee) - FSA
Flexible Spending Accounts (FSA) - Reimbursement Plan	Healthcare/Dental Reimbursement Plan Dependent Care Reimbursement Plan
Flexible Work Arrangement (FWA) Manager Log	fwa_manager_log.xlsx
FLSA Forms and Documents	FLSA Questionnaire
FMLA Revised Regulations	FMLA Revised Regulations
Form I-20 Sample	I-20 Sample
Form SSA-7028 - Sample (Notice to third party of SSN assignments)	Form SSA-7028 Sample.pdf
Form T-100	Form_T-100.pdf
Form T-200	Form-T-200.pdf
Form T-400, CERTIFICATE OF LOCATION OF PROFESSIONAL SERVICES	Form T-400 CERTIFICATE OF LOCATION OF PROFESSIONAL SERVICES	October 1, 2016
Form Template	Form Template	September 5, 2007
Free Parking Passes for Transit
Genetic Information Nondiscrimination Act of 2008	Genetic Information Nondiscrimination Act of 2008
Group Accident Insurance	Colonial Group Accident Certificate
Guide Template	Guide Template	October 17, 2006
Human Participants	Human Research Forms & Templates	September 12, 2013
Individual Development Planning - Forms and Tools	IDP Form IDP Form - SAMPLE Conversation Tool Self–Assessment Worksheets
IRS Form 8300	f8300.pdf Form 8300 Sample
Lead Administrator Feedback on Change Partner Network	Lead Administrator Feedback on Change Partner Network
Life Insurance - forms	Active and Retired C&T, S&M and Active Security Staff (local 502) Active and Retired Police Officers Active Faculty Active & Retired M&P Active Postdoctoral Associates
Life Insurance - forms	Absolute Assignment FORM
Local 35 Training Form	local-35-training-form.doc
Long Term Disability (LTD) Telephone Filing Instructions	Long Term Disability (STD) Telephone Filing Instructions
Long-Term Care	Monumental Plan
Long-Term Disability - Standard - Forms	Post Doctoral Associates and Faculty Members no YURAP Faculty, M&P Certificate Medical School Faculty Certificate Non-exempt Members Not Represented by YPBA Certificate M&P who does not participate in YURAP and Police Officers represented by YPBA Certificate
M&P Job Evaluation Questionnaire	M&P Job Evaluation Questionnaire
M&P Performance Feedback Resources	M&P Performance Management form Instructions for completing the M&P Performance Management form Sample M&P Performance Management form Self-assessment form Tips for setting SMART goals Balanced Scorecard - Template Balanced Scorecard - Example Sample M&P Performance Management goals Guidelines for getting ready for mid-year performance feedback discussions Performance Management Guide
Managed Care	Managed Care
Manager Checklist for new employees	managerchecklist-for-newemployees.pdf
Medical - Aetna Plan Members (C&T and S&M) - forms	Aetna Select (C&T and S&M) - Benefit Plan Aetna Alternate Prescription (C&T and S&M) - Benefit Plan Yale University Physician Results Form - Benefit Plan 877076_aetna_select_sob_technical_outside_ct_plan_en_2016_updated_3_1.pdf 877076_aetna_select_sob_technical_plan_el_2016_updated_3_13a-12a.pdf 877076_aetna_choice_pos_ii_sob_alternate_rx_plan_eb_2016_updated_15a.pdf 877076_aetna_choice_pos_ii_sob_base_rx_plan_ea_2016_updated_14a-2a.pdf
Medical - Aetna Plan Members (Faculty and M&P) - forms	Aetna Smart Care w/ optional Health Savings Account (Faculty and M&P) - Benefit Plan Aetna Choice (Faculty and M&P) - Benefit Plan Legacy Aetna Choice (Faculty and M&P) - Benefit Plan Schedule of Benefits - Aetna Choice POS II Medical Plan - Faculty and Managerial Employees Schedule of Benefits - Aetna Choice POS II Medical Plan - (Legacy) Faculty, Managerial & Professional, Post-Doct Schedule of Benefits - Aetna Choice POS II Medical Plan - High Deductible Health Plan - Faculty, Managerial & Professional Emplo Schedule of Benefits - Aetna Choice POS II Medical Plan - Yale Police Benevolent Association (with less than 3 years of service)
Medical - Aetna Plan Members (Security) - forms	877076_aetna_choice_pos_ii_sob_security_base_rx_plan_ef_2016_updated_2_16a-11a.pdf 877076_aetna_select_sob_security_outside_ct_plan_eo_2016_updated_3_13.pdf 877076_aetna_select_sob_security_plan_em_2016_updated_3_13b-12brev.pdf
Medical - Aetna Plan Members (Yale Police Benevolent Association)	Aetna Base Prescription (YPBA) - Benefit Plan Aetna Alternate Prescription (YPBA) - Schedule of Benefits Aetna Alternate Prescription (YPBA) - Benefit Plan Aetna Hired On or After 1-1-2012 (YPBA) - Benefit Plan (*Same Benefit Plan as M&P and Faculty) 877076_choice_pos_ii_ypba_sob_plan_g_2016-09arev3.pdf
Medical - YHP Members - forms	Yale Health Plan Members Handbook
Military FMLA Leave Amendment	Military FMLA Leave Amendment
Model COI (Conflict of Interest) Disclosure Form	Model COI (Conflict of Interest) Disclosure Form	January 28, 2013
Model COI Form	ModelCOIform.docx
New P. O. Box Request
OSHA	OSHA
Parking & Transit Request for Services
Parking and Transit Forms	Parking	August 15, 2013
Parking Application for Faculty & Staff
Parking Lot or Garage Transfer
Performance management Process - FORM	mp-performance-management-form.docx
Policy Template	Policy Template	August 17, 2006
Post-Award Partnership Agreement	Post-Award Partnership Agreement	March 1, 2016
Postdoctoral Fellow Health Care Subsidy Form	2018-healthcare-subsidy-form.pdf
Pregnancy Discrimination and Accommodation in the Workplace	ss46a_pregnancy_disability_poster.pdf
Pregnancy Discrimination and Accommodation in the Workplace - Spanish	ss46a_pregnancy_disability_poster_spanish.pdf
Procedure Template	Procedure Template	August 17, 2006
Request for Expedited Review of Corporate Clinical Trial Agreements	Request for Expedited Review of Corporate Clinical Trial Agreements
Request for Service (RIS)	Yale Printing & Publishing Services Link	February 28, 2002
Research Performance Progress Report (RPPR) Checklist	Research Performance Progress Report (RPPR) Checklist
Research Performance Progress Report (RPPR) Checklist - NIH SNAP	Research Performance Progress Report (RPPR) Checklist - NIH SNAP
Retirement Resources Forms	Financial and Benefits Planning for Retirement	April 21, 2017
Sexual Harrassment	Sexual Harrassment
Short Term Disability (STD) Telephone Filing Instructions	Short Term Disability (STD) Telephone Filing Instructions
Short-Term Disability - Forms	Short Term Disability (STD) Telephone Filing Instructions SHORT TERM DISABILITY INCOME BENEFIT PLAN
Special Permission to Serve as PI	Special Permission to Serve as PI	February 15, 2017
Special Services Van for Employees	special_service_van_form_updated_03_27_12.pdf	April 25, 2016
Special Services Van for Students	studentrequestformforspecialservicesvantransportation.pdf	April 25, 2016
Standard Life Insurance - Death Claim Form	Standard Life Insurance - Death Claim Form
Statement for Independent Personal Services Performed for Yale University Outside the United States		July 1, 2000
Storage Contract
Subaward Reconciliation Form	Subaward Reconciliation Form
Summary Annual Reports & Required Disclosures - forms	2017 YURAP Plan and Investment Notice 2017 Matching Retirement Plan - Plan Investment Notice 2017 Tax Deferred 403(b) Savings Plan - Plan and Investment Notice 2017 Tax-Deferred 403(b) Savings Plan Annual Notice 2017 YURAP Annual Notice 12/31/2016 YURAP Summary Annual Report 2017 Matching Retirement Plan Annual Notice Notice of Privacy Practices 9-23-2015 2014 Summary Annual Reports Early Retiree Reinsurance Notice Grandfathered Health Plan Notice Women’s Health Rights Under the Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA) Medicaid and the Children’s Health Insurance Program (CHIP) Women’s Health and Cancer Rights Act (WHCRA) 12/31/2016 Tax-Deferred 403(b) Savings Plan - Summary Annual Report Your Prescription Drug Coverage and Medicare (Notice) 2017 Notice of Creditable Coverage (NOCC) – Non-Medicare Plans Affordable Care Act Notice - Covered employees Affordable Care Act Notice - Non-covered employees 12/31/2016 Matching Retirement Plan Summary Annual Report FY 2016-2017 Form 5500 for Staff Pension Plan
Summary of Benefits and Coverage (SBC) Information Notices - forms	Aetna Choice® POS II - Suffix 12 Legacy Yale University: Aetna Choice® POS II - Suffix 13 - HDHP SmartCare Plan Yale University : Aetna Choice® POS II - Suffix 14 - CTSM Base RX Yale University : Aetna Choice® POS II - Suffix 15 - CTSM Alt Rx Yale University : Aetna Choice® POS II - Suffix 16 - YBPA base Rx Yale University : Aetna Choice® POS II - Suffix 17 - YPBA Alt Rx Yale University : Aetna Choice® POS II - Suffix 18 - YBPA Open Yale University : Aetna Choice® POS II - Suffix 19 - Security - Open Yale University: Aetna SelectSM - Suffix 21 - Security - non CT Residents Yale University : Aetna SelectSM - Suffix 21 - Security Open 2018_yale_health_plan_ct_sm_sbc_02212018.pdf 2018_yale_health_plan_fac_mp_sbc_02222018.pdf 2018_yale_health_plan_ypba_sbc_02212018.pdf Yale University : Aetna SelectSM - Suffix 20 - CSTM - non CT residents Yale University : Aetna SelectSM - Suffix 20-CTSM Aetna Select
Suspension of Fee Parking
TR&S Request For Service
Training Grant Encumbrance Form	Training Grant Encumbrance Form
Tuition Reduction Application	Tuition Reduction Application
USERRA	USERRA
Vehicle Disposal Form
Vehicle Disposal Form	Vehicle Disposal Web Form	September 21, 2013
Vehicle Request Form
Vision	EyeMed Vision - Basic plan for all benefits-eligible Faculty and Staff EyeMed Vision - Enhanced plan for all benefits-eligible Faculty and Staff
Workers’ Compensation - forms	Workers’ Compensation Health Service Appointment
Workers’ Compensation Act - Notice to Employees	workers-compensation-act-notice-yale.pdf
Yale Budgeting Tool (YBT) Access Request Form	Yale Budgeting Tool (YBT) Access Request Form	October 11, 2017
Yale Medical School Change of Address
Yale Transportation Options Rideshare Application
Yale University Scholar Awards Program - FACE PAGE	face-page-2018.pdf	January 4, 2018
YHP Claim Form	Pharmacy Claim Form YHP Claim Form
YSS Out of Pocket form	YSS Out of Pocket form