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Directory of Administration & Finance Forms

For questions regarding individual forms, please contact the owner listed.

Click on the column title to sort or use CTRL+F to search for keywords.

Form ↑↓ Description ↑↓ Owner ↑↓
Accident Report, Employee To be completed by all employees when they have an accident while performing work responsibilities, which includes driving.
Instructions: Employee Accident Reporting Brochure.		 Human Resource Services/Environmental Health and Safety
Accident Report, Student and Visitor (CS-13) To be completed by students or visitors who have an accident on campus. Environmental Health and Safety
Accounting Transfer To process expenditure and cash transfers between accounts. Budget and Financial Reporting Services
Allocation Transfer

To process allocation transfers within or between accounts. Allocation transfers cannot be processed between funds.
Example: You cannot transfer allocation from an IFR account to a state account.

 Budget and Financial Reporting Services
Additional Sick Leave Request Form To request additional sick leave time. Human Resource Services
Address Change Form For inactive employees to change their home address. Active employees should change their address in the SUNY Portal. Human Resource Services
Agency Account Check Request To be completed when a check needs to be issued. Please refer to the account administration webpage for specific instructions on how the forms should be completed. CAS
Agency Account Deposit Form To be completed when making deposits to an agency account. Please refer to the account administration webpage for specific instructions on how the forms should be completed. CAS
Agency Account Application and Fiscal Agent Agreement To request and authorize CAS to act as its fiscal agent for the receipt, custody and disbursements of funds. Please refer to the account administration webpage for specific instructions on how the forms should be completed. CAS
Automobile Travel, Statement of (AC 160)

Filed with a travel voucher if you are claiming reimbursement for personal automobile mileage.

 Procurement Services
Budget Request Form

To request new budget funding for salary or non-salary expenses.

 Budget and Financial Reporting Services
Campus and Division Communication Request

Complete this form when sending a mass communication to the division or the campus.

 Administration and Finance
Campus Fee Request Form To request an academic course or other campus fee. Budget and Financial Reporting Services
Cancer Screening Leave Form To document leave for cancer screening purposes. Human Resource Services
Car Rental, Authorization to Expedite Used in lieu of a travel card authorization to reserve a rental using a purchase order (PO). When using this form, no purchase requisition is necessary. Procurement Services
Car Rental, Personal vs. Rental Vehicle Cost Comparison

To calculate the cost comparison of taking a personal vehicle vs. a rental vehicle and to document that the choice made was at the lowest cost to the state.
Please note: travelers using the online Travel Authorization and Advance Form do not need to use this form as the online form includes a built-in cost calculator.

 Procurement Services
Charge of Discrimination Complaint Form

For a student or employee to file a complaint of discrimination based on the categories below.

 Human Resource Services
Chemical Purchase Order Form

To submit order request for chemicals.

 Environmental Health and Safety
Consensual Relationship Reporting Form To advise of a current or previous relationship between two employees, where one of the employees provides direct line supervision to the other employee. Human Resource Services
CP-1 (Appointment Form) This form is only used on the rare occasion that the hire is not made within the Online Recruitment System (ORS). View Instructions. Human Resource Services
CP-3 (Reappointment or Change In Status Form) Reappointment or Change in Status request for Unclassified Employees (UUP or M/C). Need help completing the CP-3 Form? View instructions. Human Resource Services
CP-3a (Adjunct Reappointment Form) To reappoint part-time academic employees in adjunct titles. Need help completing the CP-3a Form? View instructions. Human Resource Services
CSEA Annual Performance Evaluation Form (MS Word) To evaluate employees represented by CSEA. Human Resource Services
Customer Comment Card To tell us about your interaction with Human Resource Services Human Resource Services
Designated Public Forum for Free Speech, Application for Use of Use by third parties who want to exercise their rights of free speech by using the designated public forum location at SUNY Plattsburgh Internal Control/Risk Management Officer
Determination of Independent Contractor/Employee Status Form used to determine whether a person should be determined an independent contractor or employee. Must be submitted prior to work being done. Procurement Services
Direct Deposit Form Attach a copy of a voided check or stop to your bank to have it completed before submitting to payroll. Payroll Services
Direct Deposit Reactivation Form To reactivate a previously approved direct deposit form. All information (routing number, account number, etc.) must be exactly the same. Payroll Services
Discharge Notification Form To disclose an event of an oil discharge to navigable waters or adjoining shorelines. Environmental Health and Safety
Electronic Equipment Transfer/Disposal Form To dispose or transfer ownership of equipment that is no longer working, outdated, or no longer needed and has a memory (i.e., hard drives, printers, etc.) Procurement Services
Employee’s Withholding Allowance Certificate (W-4), Federal To report your federal income tax from your pay. Payroll Services
Employee’s Withholding Allowance Certificate (IT-2104), State To report your state income tax from your pay. Payroll Services
Employment Verification Form (I-9) May be filled out in advance, but must be presented with original documentation when submitting to the appropriate office. Payroll Services
Equipment Transfer/Disposal Form To dispose or transfer ownership of equipment that is no longer working, outdated, or no longer needed and does not have a memory (i.e., hard drives, printers, etc.) Procurement Services
Ethics — Honorarium Approval Form Approval form for Joint Commission on Public Ethics for Honorarium. Human Resource Services
Ethics — Official Activity Expense Payment or Service Payment Form Approval form for Joint Commission on Public Ethics. Human Resource Services
Exemption from Withholding Certificate (IT-2104-E)   Payroll Services
Exposure Incident Report Forms To report exposure to blood-borne pathogens (i.e., needle sticks). Environmental Health and Safety
Freedom of Information Law (FOIL) Request Form To request information regarding records pertaining to SUNY Plattsburgh. Internal Control/Risk Management Officer
Foreign Status of Beneficial Owner for US Tax Withholding (W-8BEN) To be completed at the same time as the Foreign Vendor Registration. Required for all new foreign vendors. Procurement Services
Foreign Vendor Registration Request To set up a new foreign vendor in the New York Statewide Financial System Procurement Services
FMLA — Certification of Health Care Provider for Employee’s Serious Health Condition Documentation to determine eligibility for FMLA due to employee’s serious health condition. For additional information, see FMLA. Downloading instructions: In order to access a form you MUST select the form name and then select “Save link as…” to save it to your documents folder. Then open from there. If you are unable to download the form, please contact Human Resource Services for a hard copy. Human Resource Services
FMLA — Certification of Health Care Provider for Family Member’s Serious Health Condition Documentation to determine eligibility for FMLA due to a family member’s serious health condition. For additional information, see FMLA. Downloading instructions: In order to access a form you MUST select the form name and then select “Save link as…” to save it to your documents folder. Then open from there. If you are unable to download the form, please contact Human Resource Services for a hard copy. Human Resource Services
Health Insurance Transaction Form PS-404 To enroll or make changes to your health insurance record. For additional information, see Health Insurance. Human Resource Services
High Risk Asset Log To inventory equipment items that are pilferable and less than $5,000. Procurement Services
Hot Work Permit To request any temporary operations involving open flames or producing heat and/or sparks. Facilities
IFR Account Request To establish a new or update an existing IFR account. Budget and Financial Reporting Services
IFR Check Request To request a refund for anyone whose payment was deposited into an IFR account. Accounting Services
Inventory Box Label To label inactive records sent to storage Internal Control/Risk Management Officer
Leave Donation Form To donate vacation accruals for the recipient to use as sick leave. Human Resource Services
Medical/Family Leave Request Form To request leave for the purposes of NYS Paid Family Leave (PFL), NYS Paid Parental Leave (PPL), or leave under the Family and Medical Leave Act (FMLA). Human Resource Services
Moving Reimbursement Agreement and Statement To request reimbursement for all applicable moving expenses. Procurement Services
Name Change Form To change your legal name due to marriage/divorce or court order. Supporting documentation is required. Human Resource Services
Near Miss Accident Report This mach form is for documenting an unplanned incident that occurred that may have resulted in personal harm or injury and can be remediated to eliminate future accidents. Printable PDF Environmental Health and Safety
New Employee Topics Checklist A list of suggested items to cover with new employees during departmental onboarding. Human Resource Services
Non-employee Travel Expense

Completed after travel to account for costs incurred and to request reimbursement for travel expenses for non-employees.
Used in lieu of the travel voucher.

 Procurement Services
Notice of Privacy Practices (Protected Health Information) Acknowledgment To complete after reading and reviewing the campus’s Notice of Privacy Practices. Internal Control/Risk Management Officer
NYS Residency Status To be completed for determination of student residency tuition purposes. Student Financial Services
Oil-Handling Log To log the training attendees for oil handling training. Environmental Health and Safety
Organizational Unit Name Change/Unit Formation Form To request a unit name change or formation of new unit. Internal Control/Risk Management Officer
Parking Deduction Authorization Form For M/C employees to authorize a biweekly deduction in lieu of an annual payment for the parking fee. Human Resource Services
Personal Information Form (Fillable) To change personal information such as gender, ethnicity, military status, or emergency contacts. Human Resource Services
Policy Transmittal Completed by sponsoring department when campus policy actions, such as revisions, new policies, or rescissions, are needed. Internal Control/Risk Management Officer
Project Sunlight Reporting Form To report any meeting of influence having to do with procurement and large scale contracts over $25,000. Internal Control/Risk Management Officer
Project Request To request campus renovations, which have prior administrative approval.  Facilities
Purchase Requisition (Jaggaer) Electronic requisitions that can be submitted through the Jaggaer system to request payment to vendors. Most payments will be through Jaggaer Procurement Services
Purchase Requisition (Out of Pocket Reimbursement) PDF requisition that can be used for submitting an employee out-of-pocket reimbursement or other non-Jaggaer) Procurement Services
Reasonable Accommodation, Request for To request a reasonable accommodation for a physical and/or mental disability. Human Resource Services
Reasonable Suspicion Form To report any reasonable suspicion. Human Resource Services
Request for Release Time for Educational Purposes To request time off for educational purposes. Human Resource Services
Security Access Request Form To obtain access to financial applications and functions such as Business Intelligence (BI), State Financial System (SFA), Finance & Management System (FMNS) Budget and Financial Reporting Services
State Card Acknowledgment Outlines terms and conditions for use of Procurement (P-Card), Travel Card, and Non-Employee Travel (NET) Card. Procurement Services
State Vehicle Request To use a state vehicle for official business Facilities
Standard Voucher (AC 92) To be completed when making payments to individuals for honorariums. Procurement Services
Statement in Lieu of Oath State employee statement in lieu of oath pursuant to civil service law §62 Human Resource Services
Supervisor Accident Investigation To document supervisors’ meeting with the employee after an accident and findings of their investigations.
Instructions: Supervisor’s Guide to Accident Reporting Brochure		 Environmental Health and Safety
Spill Report To document petroleum-based spill of over five gallons onto land or into a waterway. Environmental Health and Safety
Substitute W-9 To request taxpayer identification number and certification. Procurement Services
SUNY Tuition Waiver All state and research foundation employees are eligible to apply for one course (1–6 credits) per fiscal year at a SUNY school (benefit prorated for part-time employees). For additional details, please see the Employee Tuition Waiver page. Human Resource Services
Tax Exempt Certificate (AC 946) To certify the exemption of sales tax for goods and services for employees making purchases while performing official duties. Procurement Services
Tax Exempt, Occupancy of Hotel or Motel Rooms (ST 129) To certify the exemption from paying state-administered New York state and local sales taxes during official New York state business and staying in a hotel or motel (including New York City). Procurement Services
Telecommuting Application and Work Plan To apply for SUNY’s pilot Telecommuting Program allowing employees to conduct some of their work away from the official work site based on operational need. For additional details, please reference the full policy. Human Resource Services
Temporary Loan of Equipment To temporarily locate campus equipment for a specific time period. Procurement Services
Tent/Canopy Application and Permit Form To request the use of a tent or canopy and to obtain the permit of use. Facilities
Tenure Clock Stop Form Request to stop the clock toward continuing or permanent appointment for birth/adoption/foster care placement of a child. Human Resource Services
Trip Ticket   Facilities
Third Party Reimbursement (Non-Salary)

To identify funding that will be received from an external source to reimburse a College expenditure.

 Budget and Financial Reporting
Travel Ban, Exemption Request

Used to request an exemption to travel to a location that is currently under a travel ban.

 Procurement Services
Travel/Net Card Application Application for New York State Travel or Non-Employee Travel Card. Procurement Services

Travel Form, Authorization & Advance (Online)

 Completed prior to trip and/or when requesting an advance on certain travel expenses. The online version is preferred, but the paper version is still available for use. Procurement Services

Travel Authorization, Blanket

This form should be used by state travelers who conduct routine travel throughout a semester or fiscal year. Travelers who do not conduct routine, repeated travel should use the standard Travel Authorization and Advance Form.

 Procurement Services
Travel Over Per Diem Lodging Justification Justifies lodging that exceeds per diem rates. Procurement Services
Travel Voucher (AC 132-A) Completed after travel to account for costs incurred and to request reimbursement for travel expenses. New York state travel voucher application (Instructions) Procurement Services
Travel Voucher Audit Checklist Tool for assisting departments submit a completed travel voucher. Procurement Services
Traveler Checklist Assists travelers with preparing for state travel and includes important reminders of actions that should be taken before, during, and after travel has occurred. Procurement Services
UP-8P Request for Extra Service Form Request for Extra Service/Other Service for all employees except M/C. Human Resource Services
UUP Professional Performance Review Transmittal Form Must be attached to the review file of each UUP professional employee undergoing evaluation for reappointment, permanent appointment, annual review, or promotion. For additional forms, memos, and calendars related to this process, see Employee Evaluations. Human Resource Services
UUP Tuition Waiver All UUP-represented employees are allowed to take one course per semester or session on a space-available basis. Please complete the application and return to Human Resource Services for approval/processing. Human Resource Services
Van Drivers, Application for Approval request to be a volunteer student van driver. Human Resource Services
Vendor Selection and Price Justification Checklist This checklist is used to document selection of the vendor and the reasonableness of price when making purchases of goods and services from $2,500 and above. Procurement Services
Violence Incident Report Form A reportable violent incident should be defined as any threatening remark or overt act of physical violence against a person(s) or property whether reported or observed. Human Resource Services
Voluntary Phased Separation Program Application This program is designed to give eligible employees an opportunity for a phased approach to separation. It allows individuals to move into non-employment or retirement gradually through a voluntary reduction in work and commensurate reduction in pay. For additional information, see the complete Program Description. Human Resource Services
Voluntary Reduction Work Schedule (VRWS) Application for CSEA/PEF/MC

This program allows CSEA, PEF, or MC (06) employees to voluntarily trade income for time off. See your Collective Bargaining Agreement for additional details specific to your negotiating agreement.

Chart to determine VR Time Earned 

 Human Resource Services
Voluntary Reduction Work Schedule (VRWS) Application for UUP This program allows UUP employees to voluntarily trade income for time off. See your Collective Bargaining Agreement for additional details specific to your negotiating agreement. Chart to determine VR Time Earned Human Resource Services
Voluntary Reduction Work Schedule (VRWS) 2023–2024

Schedule for use of VR credit for the 2023–2024 fiscal year.

 Human Resource Services
Voluntary Reduction Work Schedule (VRWS) 2024–2025

Schedule for use of VR credit for the 2024–2025 fiscal year.

 Human Resource Services
Voluntary Self-Identification Disability

To voluntarily disclose a disability.

 Payroll Services/Human Resource Services
Volunteer, Application for Approval request to render volunteer services to SUNY Plattsburgh or to request access to other campus services. Human Resource Services
Waiver of Holiday Compensation — UUP Waiver of compensatory time for required holiday work for UUP-represented employees. Must be completed by May 15. Payroll Services
Waiver of Holiday Compensation

To elect to waive holiday compensation and choose to receive instead compensatory time off for holidays worked. Must be completed between April 1 and May 15. For all state employees except UUP.
Memo Regarding Waiver of Holiday Compensation.

 Payroll Services
Wildlife/Rabies Vector Species, Report of To document the presence of wildlife and/or a species capable of carrying rabies on campus (i.e., bats). A determination must be made as to whether or not there was any possibility of human exposure to rabies as it is a fatal disease. Environmental Health and Safety
Work Location Application

Used by current cleaners or janitors with permanent appointment to request a change to their work location.

 Human Resource Services
Work Log for Alternate Work Location — COVID-19

For supervisors to provide weekly summary of work performed by personnel working from alternate location during COVID-19 situation (must have approved agreement on file prior to commencing work from alternate location)

 Human Resource Services

For questions regarding individual forms, please contact the owner listed.

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