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Employment Records Research Request Form
Use this form to request employment verification for pension purposes.
Required DOE forms to file for Workers' Compensation
If you are filing for workers’ compensation, you must file these forms:
Market Rate Application Form – Informal Providers
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...
Provider retirement plan participating employer agreement form
Last updated, 3/28/23
OP 504: Request for Reimbursement for Loss or Damage to Personal Property
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.
Chemical Removal Request Form
This form for Lab Specialists is taken from the DOE Science Safety Manual.
MD-1: Request for Medical Authorization
Here is the form for an attending doctor to obtain medical authorization:
Leave balance and CAR days transfer form
This form is used for transferring leave balances and CAR days when people move to different districts/schools.
CAR Transfer Form
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.
UFT Health & Safety training request 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...
Per Session Unused Sick Time Transfer Form
This form is used to transfer accrued per-session sick leave to the employee's regular cumulative absence reserve.
DB-450: Disability Claim
Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.
Dental Claim Form
After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.
UFT Workers' Compensation Intake Form
Workers’ compensation intake form for Paraprofessionals, School Nurses, Occupational and Physical Therapists:
Staying connected
The UFT offers many different ways to stay in touch with the union and get the latest updates on your rights, benefits, discounts, workshops, campaigns and more.
DOE lactation accommodation request form (LARF) for nursing mothers
DOE lactation accommodation request form (LARF) for nursing mothers. See the current DOE lactation accommodation policy.
Membership Application (Paraprofessional)
Print and complete the paraprofessional application only if you are not able to use the online enrollment form.
Training Record Form – Informal Providers
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"...
Application for Layoff Seniority Credit for Prior Paraprofessional Service
This application form is to be used only by pedagogical personnel who have received a regular appointment.
C-257: Expense Reimbursement Form
Use this form to claim out-of-pocket expenses related to your injury or illness.
WCD-23: Employee’s Notice of Injury
Complete this form and file it with your school payroll secretary within 10 days.
Medicare Part D Reimbursement Claim Form
This is your Medicare Part D Reimbursement Claim Form, for retired members and their spouses/domestic partners.
Information for newly-appointed school counselors
The following information was sent in an email from Chapter Leader Rosemarie Thompson on Oct. 19, 2022.
What benefits do paraprofessionals who belong to the Teachers’ Retirement System (TRS) receive?
Before you retire you have: The right to borrow from your TRS account. The right to participate in the TRS tax-deferred annuity program. Benefits for your family if you die after one year of service. After you retire you receive: A guaranteed pension...
Chancellor's Regulation C-240: Teacher License Requirements
This regulation sets forth the requirements for the following licenses: Pre-Kindergarten and Elementary School Teacher, Reading Teacher, Teacher of English as a Second Language, School Media Specialist (Library), Instructional Recorder, Teaching an...
W-2 Information & Duplicate/Correction Form
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.
OP 505: Request for Reimbursement of Medical Expenses
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.
Does COBRA cover all my health benefits? What is the difference between City and Welfare Fund COBRA?
COBRA is the federal law that enables you to purchase continuation of coverage when you lose eligibility for health coverage. Most UFT members have health coverage from two separate sources: the New York City Health Plan for medical/hospital benefits...
C-3.3: Limited Release of Health Information (HIPAA)
This form allows health care providers who have treated your previous injuries to release information to your employer’s workers’ compensation insurer.
DP-2000 Election of Rate of Charge Against Annual and/or Sick Leave Balances for Absence Due to Injury Sustained in the Performance of Official Duties
Injured employees should submit this form within the first seven calendar days of absence due to injury sustained in the performance of official duties.
Join the Federation of Nurses!
Become a member of the Federation of Nurses to tap into powerful support and benefits.
HIPAA: Protected Health Information Authorization Form (PHI Form)
You may authorize the UFT to use/disclose your protected health information by filling out this form.
Optional Rider Claim Form - NYC Health Insurance Plans
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.