Jump to Footer

Directory of Administration and 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, Student and Visitor (CS-13) To be completed by students or visitors who have an accident on campus. Environmental Health & Safety
Address Change Form (PDF) For inactive employees to change their home address. Active employees should change their address in the SUNY Portal. Human Resource Services
Administrative Policy Transmittal Completed by sponsoring department when administrative policy actions, such as revisions, new policies, or rescissions, are needed. Management Services
Agency Account Check Request To be completed when a check needs to be issued. Please refer to the policy and procedure document above 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 policy and procedure document above 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 policy and procedure document above for specific instructions on how the forms should be completed. CAS
Alleged Safety or Health Hazards, Notice of To report an observed potential safety or health hazard for investigation. Environmental Health & Safety
Asset Relocation Form To move equipment with a SUNY Property Control barcode to another room or location.  Management Services
Automobile Travel, Statement of (AC 160)

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

Accounts Payable
Budget Allocation Transfer

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

Budget and Financial Reporting Services
Budget Request Form

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

Budget and Financial Reporting Services
Budget Suggestion Form

To submit any suggestions regarding the Budget and Financial Reporting Services.

Budget and Financial Reporting Services
Campus Fee Request Form To request an academic course or other campus fee. Budget and Financial Reporting Services
Cancer Screening Leave Form (Fillable MS Word) 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. Accounts Payable
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.

Accounts Payable
Cash Transfer Form

To transfer funds between accounts.

Budget and Financial Reporting Services
Child and Youth Protection Training Acknowledgment To acknowledge participation and understanding of biennial training by covered persons. Management Services / University Police
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
Covered Persons Sex Offender Registry Check Clearance To be completed by covered person(s) involved in an event involving children prior to event. Management Services/University Police
CP-3 (Reappointment or Change In Status Form) (MS Word) 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) (MS Word) 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 (PDF) 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 Management 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
Discharge Notification Form To disclose an event of an oil discharge to navigable waters or adjoining shorelines. Environmental Health & 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.) Management Services
Employee Accident Report 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 & Safety
Employee Safety Concerns To report an experience that occurred to you for investigation and/or remediation. Environmental Health & Safety
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
Student 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
Employment Verification Form (I-9) May be filled out in advance, but must be presented with original documentation when submitting to the appropriate office. State employees submit to Human Resource Services. Human Resource 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.) Management Services
Exemption from Sexual Molestation Insurance Requirements, Request for To request exemption from third-party liability policy coverage no less than one million ($1,000,000). Management Services / University Police
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 & Safety
Freedom of Information Law (FOIL) Request Form To request information regarding records pertaining to SUNY Plattsburgh. Management Services
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. Purchasing Services
Foreign Vendor Registration Request To set up a new foreign vendor in the NYS State Financial System Purchasing Services
Employee Suggestion Form (MS Word) To submit suggestions that can result in specific improvements, cost savings, or other enhancements to the campus. Human Resource Services
Ethics - Honorarium Approval Form (Fillable MS Word) Approval form for Joint Commission on Public Ethics for Honorarium. Human Resource Services
Ethics - Official Activity Expense Payment or Service Payment Form (Fillable MS Word) Approval form for Joint Commission on Public Ethics. Human Resource Services
FMLA — Certification of Health Care Provider for Employee's Serious Health Condition (PDF) Documentation to determine eligibility for FMLA due to employee's serious health condition.  For additional information, see FMLA. Human Resource Services
FMLA — Certification of Health Care Provider for Family Member's Serious Health Condition (PDF) Documentation to determine eligibility for FMLA due to a family member's serious health condition.  For additional information, see  FMLA. Human Resource Services
Health Insurance Transaction Form PS-404 (PDF) 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 $2,500. Management Services
Hold Sponsored Activity Involving Children, Request to To request an College or a college-affiliated organization event or activity involving children on campus. Management Services / University Police
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 Management Services
Journal Expenditure Transfer To transfer expenses from one account to another. Accounts Payable
Leave Donation Form (Fillable MS Word) To donate vacation accruals for the recipient to use as sick leave. Human Resource Services
Moving Reimbursement Agreement and Statement To request reimbursement for all applicable moving expenses.  Accounts Payable
Name Change Form (PDF) To change your legal name due to marriage/divorce or court order. Supporting documentation is required. Human Resource Services
Near Miss Accident Report To document an unplanned incident that occurred that may have resulted in personal harm or injury and can be remediated to eliminate future accidents. Environmental Health & Safety
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.

Accounts Payable
Notice of Privacy Practices (Protected Health Information) Acknowledgment To complete after reading and reviewing the campus' Notice of Privacy Practices. Management Services
Organizational Unit Name Change/Unit Formation Form To request a unit name change or formation of new unit. Management Services
Personal Information Form (Fillable) To change personal information such as gender, ethnicity, military status, or emergency contacts. Human Resource Services
Procurement/Exxon Mobil Gas Card Application To apply for a SUNY Citibank Procurement Card or Exxon Mobile Gas Card. Purchasing Services
ProfTech Workplace Solutions Online Ordering Request Form To create an online user account with ProfTech. Purchasing Services
Project Sunlight Reporting Form To report any meeting of influence having to do with procurement and large scale contracts over $25,000. Purchasing Services
Purchase Requisition Authorization for a purchase. Purchasing Services
Revenue/Expenditure Transfer Form To change an expense to an account and transfer payment to an IFR or Student's account. Accounting 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. Accounts Payable
State Vehicle Request To use a state vehicle for official business Facilities
Standard Voucher (AC 92) To be completed when making payments to vendors. Purchasing
Statement in Lieu of Oath (PDF) 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 & Safety
Spill Report To document petroleum-based spill of over five gallons onto land or into a waterway. Environmental Health & Safety
Substitute W-9 To request taxpayer identification number and certification. Purchasing Services
SUNY Tuition Waiver (PDF) 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. Purchasing 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 (not New York City).
Accounts Payable
Temporary Loan of Equipment To temporarily locate campus equipment for a specific time period. Management 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 (Fillable MS Word) 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)

Complete when a third party has paid or will pay for a good or services other than personal services (OTPS)
Instructions for Reimbursement After Payment
Instructions for Reimbursement Prior to Payment

Accounts Payable / Accounting
Travel Ban, Exemption Request

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

Accounts Payable / Management Services
Travel / Net Card Application Application for Citibank Visa Travel or Non-Employee Travel Card. Accounts Payable

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. Accounts Payable

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.

Accounts Payable
Travel Over Per Diem Lodging Justification Justifies lodging that exceeds per diem rates. Accounts Payable
Travel Voucher (AC 132-A) Completed after travel to account for costs incurred and to request reimbursement for travel expenses. NYS Travel Voucher Application (Instructions) Accounts Payable
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. Accounts Payable
UP-8P Request for Extra Service Form (Fillable MS Word) Request for Extra Service/Other Service for all employees except M/C. Human Resource Services
UUP Professional Performance Review Transmittal Form (PDF) 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 (PDF) 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 (PDF) 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. Purchasing Services
Violence Incident Report Form (Fillable MS Word) 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 (PDF) 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 (Fillable MS Word) 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 (PDF) Human Resource Services
Voluntary Reduction Work Schedule (VRWS) Application for UUP (Fillable MS Word) 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 (PDF) Human Resource Services
Voluntary Reduction Work Schedule (VRWS) Schedule 2019-20 (PDF)

Schedule for use of VR credit for the 2019–2020 fiscal year.

Human Resource Services
Voluntary Reduction Work Schedule (VRWS) Schedule 2020–21 (PDF)

Schedule for use of VR credit for the 2020–2021 fiscal year.

Human Resource Services
Waiver of Holiday Compensation — UUP Waiver of compensatory time for required holiday work for UUP-represented employees. Must be completed between July 1 and August 15. Payroll Services
Volunteer, Application for (PDF) Approval request to render volunteer services to SUNY Plattsburgh or to request access to other campus services. Human Resource 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 & Safety
Work Location Application (PDF)

Used by current Cleaners or Janitors with permanent appointment to request a change to their work location.

Human Resource Services

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

Back to top