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.

This form is used for transferring leave balances and CAR days when people move to different districts/schools.

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

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.

The UFT Health & Safety Department offers workshops on health and safety issues on staff development days, union meetings, etc. If you would like to have one of these workshops offered to your chapter, please fill out this form and send it to the...

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

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

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

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

DOE lactation accommodation request form (LARF) for nursing mothers. See the current DOE lactation accommodation policy.

Print and complete the paraprofessional application only if you are not able to use the online enrollment form.

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"...

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

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

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

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

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.

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

Injured employees should submit this form within the first seven calendar days of absence due to injury sustained in the performance of official duties.

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

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.

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.

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...

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

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.

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...

The employer is required to fill out this report within 10 days to notify the Workers’ Compensation Board of your work-related injury or illness. You should not participate in filling out this form. See the C-2: Employer's Report - Filing Procedure...

Your doctor must fill out this form at regular intervals — usually every 4-6 weeks — during your convalescence. It is used to determine your level of benefits — so it is very important that your doctor fills it out carefully.

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...