1. Health/Welfare Funds
2. Pension/Tax Deferred Annuities (TDA)
3. Payroll Information/Timekeeping
4. Workers Compensation
5. Retirees
   
   

Health/Welfare Funds

    Summary of Benefits

• Instructional Staff
• Executive Compensation Plan
• Doctoral Student Health Plan
• Adjunct Benefits (Non Doctoral Student)
• Classified Managerial

    Welfare Funds

• PSC/CUNY Welfare Fund (Instructional Staff)
• DC 37 (White Collar & Blue Collar Classified Staff)

    Additional Programs

• New York City Health Benefits Program
• NYC Health Insurance Plan Rates
• NYC Flexible Spending Account (FSA) Program
• CUNY Work/Life Program
• Transit Benefit
• New York’s 529 College Savings Program
• PICA Program

    Benefit Forms

Health Benefit Forms:

• Health Benefits Application
• Health Benefit Buy-out Waiver Program
• Flexible Spending Application
• Young Adult Coverage to Age 26
• Young Adult Option to Age 29
• GHI Health Insurance Claim

Dental Plan:

• Dental Claim Form (DC37)
• Dental Claim Form: Guardian (PSC-CUNY)
• Delta Enrollment Form (PSC-CUNY members) 
• Delta Disenrollment Form (PSC –CUNY members)

Optical Form (for PSC- CUNY Members):

• PSC-CUNY Welfare Fund Optical Reimbursement

PSC CUNY Forms:

• Extended Medical Claim Form (NY City employees)
• Weight Watchers Claim Form

Disability Forms:

• Long Term Disability Benefits Claim Packet (Instructional Staff)

Beneficiary Forms:

• Death Benefit Beneficiary Designation Form (Instructional Staff)
• Death Benefit Beneficiary Designation Form (Non-Instructional Staff)

Leave Applications:

• Application to Donate Dedicated Leave
• Application to Receive Dedicated Leave
• Family & Medical Leave Act (FMLA) Request Form
• FMLA Certification of Health Care Provider For CUNY Employees
• FMLA Certification of Health Care Provider for Family Members
• FMLA Certification of Health Care Provider for Covered Military Service Members
• Paid Parental Leave Application

Other:

• Salary Reduction Agreement (TIAA CREF, METLIFE, HRC)
• Fellowship Application
• Fellowship Instructions
• Tuition Waiver

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Pension/Tax Deferred Annuities (TDA)

    Pension Providers

• TIAA-CREF Retirement System (TIAA-CREF)
• The Teachers’ Retirement System of the City of New York (TRS)
• New York City Employees’ Retirement System (NYCERS)

    Tax Deferred Annuities (TDA)

• NYC Teachers’ Retirement System (for TRS members only)
• TIAA CREF
• HRC –Halliday Financial
• Metlife
• New York State Deferred Compensation Plan (457)

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Payroll Information/Timekeeping

    Payroll Forms

• Federal Tax W-4
• State Certificate of Tax Withholding (IT 2104)
• Direct Deposit Form
• Direct Deposit Addendum Form

    Holiday & Payroll Calendars

• Employee Holiday Calendar
• College Assistant Timesheet Calendar
• Payroll Calendar - Full Time Employees
• Payroll Calendar - Executive Compensation Plan Employees
• Adjunct Paydate Schedule
• Non-Teaching Adjunct Paydate Scheduled

    Timesheets

• College Assistant Timesheet
• Adjunct CLT Timesheet
• Non-Teaching Adjunct Timesheet
• On-Line Timesheet for Full Time Classified and Non-Teaching Instructional Staff
• Instructions to complete Online Timesheets (Non Instructional &
  non-teaching Instructional staff)

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Workers Compensation

• Employee’s Notice of Injury (WCD23)
• CSI Workers Compensation Questionnaire
• Explanation of Charge Against Leave Balance (DP 2002)
• Witness Report Statement (WCD26)
• Supervisor’s Report of Injury (WCD201)

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Retirees

• TIAA CREF Medicare Part B Reimbursement
• City of New York Health Benefits Program Retirees FAQ’s
• Medicare
• Social Security
• DC 37
• PSC Welfare Fund