For more information, contact us at payroll@pittstate.edu.

Accident Report Forms

• ***Follow accident instructions on PSU Workers Compensation webpage
• Employer's Report of Accident (Complete online): State Self Insurance Report of Incident
• PSU Incident Report

Acknowledgement and Agreement

Advanced Leave Agreement (Fillable PDF)

Affordable Care Act (ACA) - New Health Insurance Marketplace Coverage Options & Your Health Coverage

Authorization Form for Release of Medical Information (Fillable PDF)

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

Clothing Policy Forms

• Taxability Determination Form (Fillable PDF)
• Department Business Attire Item Policy

Compensatory Time Agreement for Non-Exempt Employees

Conflict Resolution/Grievance Review Request Form (Fillable PDF)

Direct Deposit (EFT) Authorization Form

Donor Leave Request Form (Fillable PDF)

Employee Change Request Form- Employees With No Benefits (Students, Graduate Assistants, USS and Unclassified) *Use GUS Recruit Dashboard Form: "Employee Change Request - Direct Reports (Students, Graduate Assistants, USS and UNC No Benefits)"*

Employee Information Sheet

Extra Duty Compensation Form 

Fair Labor Standards Act (FLSA) Forms

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

Family and Medical Leave (FMLA) Forms

• FMLA Leave Request Form (Fillable PDF)
• Certification of Health Care Provider for Employee (Fillable PDF)
• Certification of Health Care Provider for Family Member (Fillable PDF)
• Certification of Qualifying Exigency for Military Family Leave (Fillable PDF)
• Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (Fillable PDF)

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

Funeral Leave Request Form (Fillable PDF)

Group Health Insurance (GHI) Forms -

• GHI Enrollment Form - Enrollment is done online in the SEHP Membership Administration Portal
• GHI Change Form - contact HRS regarding changes

Holiday Overtime Reporting (Fillable PDF)

I-9 Form (Fillable PDF, If you have issues filling out online, try a different browser.)

Independent Contractor / Consultant Certification & Request to Pay Worksheet

K-4 - Kansas Income Tax Withholding (Fillable PDF)

KPERS

• KPERS Name Change Form (Fillable PDF)
• KPERS Report of Member Status (Fillable PDF)
• KPERS Beneficiary Form - KPERS Retirement Plan (Fillable PDF)
• KPERS No Prearranged Employment Form (Fillable PDF)

Learning Quest Payroll Deduction Forms

Life Insurance Beneficiary Form - Regents Retirement Plan (Fillable PDF)

Life Insurance - Conversion Option (Fillable PDF)

Life Insurance - Portability Option (Fillable PDF)

MO W-4 - Missouri Income Tax Withholding (Fillable PDF)

MO W-4C - Missouri Income Tax Withholding Waiver (Fillable PDF)

Nine Pay Twelve Salary Payment Option

Oath of the State of Kansas

Oath of the State of Kansas - Student Employees

Overtime Approval Form (Fillable PDF)

Parental Leave Request Form

Payroll Forms

• Payroll Correction Form (online form)
• Payroll Retroactive Costing Changes (online form)
• Verify Taxable Fringe Benefit Form (online form)

Phased Retirement Sample Agreement (PDF)  (Word)

Performance Management Counseling Checklist

Performance Review Process

• University Support Staff and Unclassified Performance Review Form

Position Descriptions

• University Support Staff and Unclassified
  
  • Position Description Form (Word)
  • Position Review Request Form

Position Details Worksheet

Property Issuance and Return Agreement

PSU COVID-19 Leave Request Form

PSU Foundation Payroll Deduction Form (PDF)

PSU ID Worksheet

Retirement Plan Investment Agreement - Regents Mandatory Retirement Plan (Fillable PDF)

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - Pre Tax (Fillable PDF)

Retirement Plan Investment Agreement - Voluntary Tax Sheltered Annuity Plan - After Tax Roth (Fillable PDF)

Retirement Verification

Shared Leave State of Kansas Program (University Support Staff and Non-KNEA Members)

• Leave Request Form (Fillable PDF)
• Donation Form (Fillable PDF)
• Health Care Provider Statement (Word)

Shared Leave - KNEA Program

• Leave Request Form (Fillable PDF)
• Donation Form
• Health Care Provider Statement

Social Security Exemption Notification

Standard Evaluation Form of Applications

State of Kansas Tax Clearance Program Employee Acknowledgement

Substance Abuse Policy Affirmation Form

Substantial Presence Worksheet - 2022

Substantial Presence Worksheet - 2021

Temporary University Support Staff Position Acknowledgment

Telework Request Form (Temporary)

Time Sheets

• Late Timesheet Submission Form (online form)
• Hourly Employee - No Benefits (Fillable PDF)
• Employee with Benefits

Tuition Assistance Applications

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

Volunteer Agreement and Release (Fillable PDF)

W-4 - Federal Income Tax Withholding (Fillable PDF)

Withdrawals from the Kansas Board of Regents Mandatory Retirement Plan

Withdrawals from the Kansas Board of Regents Voluntary Retirement Plan