Processes and Procedures
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Benefits General Business
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New Hire Enrollment in University Benefits
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Group Benefits
Enrollment Form
(PDF)
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Change your Name and/or Address with the University and your Benefits
Vendors ( Social Security Cards are required to change name in the University of Arkansas Payroll System). |
Name/Address
Change Form
(PDF)
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Add Life, Dependent life, A D&D, Optional Long Term Disability. Change beneficiaries for Life Insurance and Accidental Death and Dismemberment (Adding Life insurance, Dependent Life insurance or Long Term Disability insurance require the completion of additional forms. These forms are available in your Benefits office. Beneficiary changes take place the date the completed forms are received in the Benefits Office).
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Group Benefits
Change Form
(PDF)
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Health Coverage Changes
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Health Insurance Enrollment, Termination, Deletion of Dependents. (New Employees Health coverage is effective the 1st of the month following the date the Benefits Office receives all required New Hire Forms. In order to make any changes to your Health coverage when paying your premiums with pre-tax dollars you must have a qualifying event . The required forms must be received in the Benefits Office within the 31 day eligibility period after the event.) See Qualifying Events.
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*You may only make changes to Health coverage taken on a pre-tax basis during the annual election period in November or with a Qualifying Life Event.
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Change Primary Care Physician (PCP changes are effective the 1st of the following month as long as the completed PCP change forms are received at QualChoice by the 25th of the current month. Example exceptions include; current PCP has left or is leaving the Network, no previous selection of PCP. These changes may take place immediately as per QualChoice's discretion. In most other instances a PCP may only be changed every six months.)
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QualChoice PCP
Change Form
(PDF)
May be changed by phone directly through QualChoice at 1-800-235-7111
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Submit Health Care Claim form for services previously paid for.
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QualChoice Medical
Services Claim Form
(PDF)
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Submit Prescription Drug Claim form for prescriptions paid for in full. (excluding co-pay)
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PharmaCare Pharmacy Claim Form (PDF)
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Flexible Benefit Plan
Retirement Contribution Changes
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Increase or Decrease Retirement Contributions (Changes to your retirement contributions are effective the 1st day of the following month after the Benefits Office receives the completed forms.)
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Salary Reduction / Deduction Agreement Form
(PDF)
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Change the percentage and/or destination retirement company to which your retirement contributions are being made (Changes to your retirement contributions are effective the 1st day of the following month after the Benefits Office receives the completed forms.)
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Investment Election Form
(PDF)
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Employment Forms for New Employees
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All new employees should complete the following forms within the first three
days of hire. Payment of first paycheck may be delayed if these forms are not
completed in a timely manner. Contact Human Resources for assistance. |
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Form |
Purpose |
Distribution/Retention |
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Form I-9
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Confirms identity and documents eligibility to work in the United States, as
governed by the Department of Homeland Security, U.S. Citizenship and
Immigration Services.
The Form I-9 must be completed within the first three days of employment.
Click here for: How to Complete a Form I-9: Prepared for University of Arkansas
Departments.
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Hiring departments complete and sign Section 2 of the form after reviewing
original document(s) provided by the employee. The original Form I-9 and
photocopies of the document(s) are forwarded to Human Resources, 222 ADMN,
unless the individual is a Non-Resident Alien.
Hiring departments should advise Non-Resident
Aliens, to contact Human Resources to schedule an appointment to complete
the employment forms.
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University
Acknowledgement of Policies Form
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Satisfies notification compliance with the U.S. Drug Free Workplace Act of 1988
and documents an employee’s notification of important employment-related
policies. |
The original form should be forwarded to Human Resources, 222 ADMN.
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Form W-4
English
Spanish |
Instructs the Payroll office to withhold the correct amount of income tax from
the employee’s paychecks. |
The original form should be forwarded to Human Resources, 222 ADMN.
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Direct Deposit Authorization
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Directs employee’s pay to be disbursed directly to a financial institution that
receives electronic transfers. Employees can receive their earning statements by
e-mail.td>
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The original form and a voided check for each account listed should be forwarded
to Human Resources, 222 ADMN.
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Personnel Data Form |
Collects the employee’s emergency contact information, prior state service, and
voluntary self-reported data used in Federal reporting.
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Departmental representatives with access to the PERS module in BASIS may enter
data into the PDAT screen once the wage rate or PACT is approved. The form
should be shredded after data entry is completed.
Departmental representatives who do not have access to PERS need to request it
via their department head. The request can go to
jcarey@uark.edu or
bshoemak@uark.edu.
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