Forms and On-Line Changes

The following are forms that are available for download from this site. You must have Adobe Acrobat Reader 3.0 in order to use these forms.

To read the documents marked PDF requires "Adobe Acrobat". On campus users can contact #4600 for assistance.

NOTE: These forms are available for PSU Employees only

The forms below are available directly on-line either as an HTML file, or for download into Adobe Acrobat Reader 3.0. For those not yet available on-line, you can complete the HRS Forms Request page and a form will be sent to you.

Accident Report Forms

• Employer's Report of Accident (PDF) (Word Doc)
• PSU Incident Report (PDF) (Word Doc)

Address Change (Word) (PDF)

Authorization Form for Release of Medical Information

BCBS/Kansas Choice Medical Claim Form

Change Checklist (Changes in Name, Address, Marital Status & Number of Children) ) (Word) (PDF)

Classified Appointment Form (Temporary Position)

Classified Position Allocation Form(Benefits - Eligible Position)

Classified Position Description Form (PDF) ( Word)

Classified Position Review Request Form

Classified Staff Recruitment Record

Compensatory Time Agreement for Non-Exempt Employees

Consultant Agreement/ Independent Contractor/ Consultant Worksheet

Credit Card Application - VISA BTC

Delta Dental Claim Form

Direct Deposit (EFT) Authorization Form

Donor Leave Request Form

Employee Information Form (Word) (PDF)

Employee Suggestion Form

Extra Duty Compensation Form (Excel) (PDF)

Fair Labor Standards Act (FLSA) Forms

• FLSA Questionnaire (Word) (PDF)
• FLSA Compliance Checklists:
• -- Executive Exemption
• -- Administrative Exemption
• -- Professional Exemption
• -- Computer Exemption

Family and Medical Leave (FMLA) Forms

• FMLA Leave Request Form
• FMLA Medical Certification of Health Care Provider Form

Funeral Leave Request Form (KAPE Service & Maintenance Employees ONLY)

Funeral Leave Request Form

Group Health Insurance (GHI) Forms

• GHI Communication Form (PDF)
• GHI Dependent Grandchild Affidavit (PDF)
• GHI Request for Enrollment of Common Law Spouse (PDF)

Holiday Overtime Reporting

I-9 Form - All employees except student employees and graduate assistants

I-9 Form - Student employees and graduate assistants

K-4 - Kansas Income Tax Withholding

KanElect Flexible Spending Forms

• KanElect Flexible Spending Claim Form (PDF) (Word)
• KanElect Flexible Spending Communication Form
• KanElect Flexible Spending Direct Deposit Authorization
• KanElect Flexible Spending E-Mail Notification Authorization

KPERS

• KPERS Name Change Form
• KPERS Report of Member Status
• KPERS Beneficiary Form - KPERS Retirement Plan

Learning Quest Payroll Deduction Change Form

Life Insurance Beneficiary Form - Regents Retirement Plan

Name Change Form (Word) (PDF)

Nine Pay Twelve Salary Payment Option

Oath of the State of Kansas

Oath of the State of Kansas - Student Employees

Overtime Approval Form

Phased Retirement Sample Agreement (PDF) (Word)

Prescription Drug Program Grievance Form

Public Relations Information Sheet

Retirement Plan Investment Agreement - Regents Mandatory Retirement Plan (Word)

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan

Retirement Withdrawal Verification Form - Regents Mandatory Retirement Plan (PDf) (Word)

Shared Leave State of Kansas Program (Classified and Non-KNEA Members)

• Leave Request Form
• Donation Form
• Health Care Provider Statement

Shared Leave - KNEA Program

• Leave Request Form
• Donation Form
• Health Care Provider Statement

Social Security Exemption Notification

State of Kansas Tax Clearance Program Employee Acknowledgement

Substance Abuse Policy Affirmation Form

Substantial Presence Worksheet - 2008

Suggestion Award Form

Temporary Classified Position Acknowledgment

Timesheet (Word) (PDF)

Tuition Assistance Applications

• Employee (non-Faculty) Tuition Assistance
• Dependent Child(children) Tuition Waiver
• Spouse Tuition Assistance Application
• FERPA Release
• Tuition Tax Status

W-4 - Federal Income Tax Withholding