Moving forward, all informal providers will receive the standard 2007 market rate without having to apply. In order to receive the 2007 rate retroactively, informal providers must apply for it and attest that their cost of care has increased. Please...

Registered family and licensed group providers whose rates listed on file with ACS are not already higher than the 2007 market rate should use this form to apply to receive the new market rate moving forward and retroactively.

Informal providers should use this form to record any training sessions they attend. Informal providers who complete 10 or more hours of approved training in at least two different approved topics may be eligible to receive a higher, "enhanced"...

If you have performed SESIS-related activities at home because you have been directed to do so, you can file a grievance within thirty (30) school days from the time you were instructed to perform the activity.

Have you had to work beyond your regularly scheduled work day within the past 30 school days? If so, please provide us with specific details of what happened, when it happened, what if anything you did to try to rectify the problem, if you were...

If you are filing for workers’ compensation, you must file these forms:

Educational paraprofessionals should use this form for initial requests for leaves of absence as well as requests for extensions. Requests for extensions must be submitted prior to the date of expiration of the current leave.

You should submit this report with your Educational Paraprofessional Leave Application to prevent the disruption of your major medical insurance.

Administration for Children's Services Division of Child Care/Head Start Child Care Support Services; Provider / Program Enrollment or Update Request

Office of School Health Time Report for Nurses.

This form is used to request a correction or duplicate W-2 for the current tax year and/or the three previous years. Requests for earlier W-2s are handled by the Office of Payroll Administration or the Office of Employment Records Research.

This form is used by school nurses and occupational and physical therapists.

Although the cost of anesthesia for hospitalization, emergency illness or accidental injury should be covered in full by HIP/HMO, the Welfare Fund will pay 80% of reasonable, usual and customary charges when not covered by HIP/HMO.

Members on an approved Child Care Leave who are currently covered by the UFT Welfare Fund are eligible to receive extended UFT Welfare Fund benefits for up to a maximum of six (6) consecutive months for the birth or adoption of a child.

These instructions explain how to fill out your dental claim form either after treatment or for pre-treatment estimates for more complicated procedures such as periodontic surgery, bridges, crowns, inlays, dentures and other procedures that cost over...

As a new member you are automatically enrolled in the Scheduled Benefit Plan. If you wish to enroll in one of the other UFT Welfare Fund dental options use this form. All other members and retirees who wish to transfer from one UFT Welfare Fund...

Fill out and have this form notarized for your dependent child to ensure coverage by the UFT Welfare Fund benefit plan.

This fully explains the benefits available under the UFT Welfare Fund Direct Access Dental Plan (SIDS – Self-Insured Direct Services) and includes a subscription form at the end.

Fill out and have this affidavit notarized to cover unmarried children over age 26 who cannot support themselves because of a mental illness, developmental disability, mental retardation or physical handicap under the UFT Welfare Fund Benefit Plan....

Include all original pharmacy receipts with prescription detail clearly noted which must include the name, strength, quantity and price. Please attach to this form. Receipts must be mailed within 90 days from date of service. Reimbursement will be in...

For NYCE PPO in-service members only, the Welfare Fund will reimburse up to $100/year of the deductible for the purchase or rental of durable medical equipment, with this form and an original Explanation of Benefits (EOB).

Read this notice of privacy practices to understand how protected health information about you may be used and disclosed and how you can get access to this information.

You can choose a personal representative(s) to share your health information with by filling out this form.

You may authorize the UFT to use/disclose your protected health information by filling out this form.

For HIP subscribers only, use this In-Hospital Private Duty Nursing Claim Form for the UFT Welfare Fund to cover the costs, after a 72-hour deductible, of 80% of the usual and customary costs of in-hospital services provided by a registered nurse...

This price waiver form must be completed by both the member and his/her physician in cases where a brand rather than generic prescription is deemed medically necessary.