Salary differentials application form used by F/Z/O status and Adult Education teachers

Teacher's Choice participants use this form to inform their school principal of purchases made with Teacher's Choice funds. Once completed, attach all original receipts/invoices and submit to your school principal for review.

Use this form to document a hazardous chemical exposure incident in your school. Parts I, II, and III of the form are included.

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.

Use this form to request employment verification for pension purposes.

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

This form is for payroll secretaries.

This form must be completed and submitted to the per session supervisor prior to commencement of employment in a per session activity. Waivers for per session activities that will exceed 400 hours must be submitted electronically through the DOE's...

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...

The DOE will reimburse you up to $500 per school year for stolen or destroyed property such as loss or damage to personal clothing and personal accessories. For reimbursement of eyeglasses damaged in assault cases, use form OP 505G.

This form for Lab Specialists is taken from the DOE Science Safety Manual.

All pedagogues and paraprofessionals may use this form to donate sick time to a colleague. The recipient receives one day for every two days donated. Sick leave transfer rules are on page 2 of the form.

View or download the Green Apple guide to UFT Welfare Fund health benefits for in-service members and their families.

Here is the form for an attending doctor to obtain medical authorization:

Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.

This form is used to transfer accrued per-session sick leave to the employee's regular cumulative absence reserve.

Workers’ compensation intake form for Paraprofessionals, School Nurses, Occupational and Physical Therapists:

Legal referrals injury claim form

Use this confidential form to notify the UFT School Safety Department if you have been the victim of an incident and/or injury. Or fill out the online incident report form.

Once line-of-duty status has been approved, you can use this form to request reimbursement for out-of-pocket medical expenses to a maximum of $1,500.

This application form is to be used only by pedagogical personnel who have received a regular appointment.

Complete this form and file it with your school payroll secretary within 10 days.

Use this form to claim out-of-pocket expenses related to your injury or illness.

This is your Medicare Part D Reimbursement Claim Form, for retired members and their spouses/domestic partners.

Please complete this form if you would like to cancel the Electronic Fund Transfer (EFT) or Direct Deposit of one or both of the following: a) your monthly retirement allowance under the Qualified Pension Plan (QPP); or b) your monthly annuity...

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.

This form allows health care providers who have treated your previous injuries to release information to your employer’s workers’ compensation insurer.

This form is for retired members who have elected a New York City optional rider or New York City health plan, or are covered under their spouse’s/domestic partner’s NYC health plan.

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"...

You must fill out this form to initiate your Workers’ Compensation claim. You should retain one copy, file a second with the Board, and provide a third to your legal representative.

This form details the nature of your injuries. It should be turned in to your principal within 24 hours of your accident or illness.

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).

Please file this form only if you meet one or both of the following conditions: You are receiving Qualified Pension Plan (QPP) and/or Tax-Deferred Annuity (TDA) payments from TRS through Electronic Fund Transfer (EFT); and The account number at your...

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...