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Forms

(by category)

Important Note: Most of the forms are in Portable Document Format (PDF). The forms have fields to be filled out online using Adobe Acrobat Reader version 4.0 or later. PDF forms should then be printed using the printer icon near the upper-left corner of the form. PDF forms with data cannot be saved or e-mailed unless "Save with 7.0+" is in the description. Read the form instructions closely. Many forms require signatures and hardcopy submission.

Affiliate/Contractor/Zero Pay

Contractor Access Form

For use in hiring contractors.

Zero Pay Temporary Appointment

For use in appointing Zero Pay (ZP/volunteers) staff and students.

Zero Pay Adjunct Appointment

For use in appointing Zero Pay (ZP/volunteers) adjunct faculty.

Benefits

Insurance Forms

Link to ALL PEBA Insurance Forms.

PEBA Notice of Election Form 

Insurance enrollment or changes.

Affordable Care Act Request for Review of Healthcare Coverage Eligibility

and Process

Appeal form for ACA eligibility and process.

PEBA Certificate Regarding Tobacco Use

Certification of Non-Tobacco/Tobacco Use.

SC Public Employee Benefit Authority (PEBA) Name/Address Change

PEBA Name/Address Change form. Employees can also update their addresses for Insurance purposes by going to mybenefits.sc.gov.

Health

State Health Plan (SHP)

State Health Plan Benefits Claim Form and Instructions

State Health Plan expenses claim form.

Prescription Drug Reimbursement/Coordination of Benefits Claim & Form Instructions

Express Scripts prescription drug claim form.

Prescription Drug Home Delivery Order Form

Express Scripts home delivery order form.
COBRA

PEBA COBRA Notice of Election form

For COBRA subscribers.

PEBA COBRA Rates Chart

COBRA Monthly Premiums.
Dental

PEBA State Dental Claim Form and Instructions

State Dental Plan claim form.
 Money Plu$

PEBA Notice of Election Form

See PEBA MoneyPlus information.

MoneyPlu$ Claim Form

Medical Spending Account and Dependent Care Spending Account reimbursement form.

Retirement

Retirement Forms

Link to ALL retirement forms.

Enrollment Form

For Use in ALL systems.

Beneficiary Form

For use in ALL systems, except State Optional Retirement Plan.

Beneficiary/Trustee Designation Form

For use in ALL systems, except State Optional Retirement Plan.

Election of Non-Membership

PEBA Election of Non-Membership form.

State Optional Retirement program (ORP) Active Group Life Beneficiary Form

SC ORP Active Incidental Death Benefit Beneficiary Designation.

Amount Change form for Supplemental Retirement Account

College's Annuity Amount Change form. (401K, 457, and/or 403b)

Compensation

Employee Bonus/Award Request Form

Compensatory Overtime Record

Request to Change Accrual Type

Request for Additional Pay

Request for Salary Change

Request for Temporary Salary Adjustment 

Employment, Hiring, and Separation

Employment Verification Release

S2 Background Check Disclosure, Release, and Authorization Forms (without credit check)

S2 Background Check, Disclosure, Release, and Authorization Forms (with credit check)

Request for Temporary Employee Posting/Hire Authorization

Hire Authorization Form is not required for classified staff and temporary PeopleAdmin recruitments

Faculty Hire Authorization Form

Adjunct Appointment

Temporary Appointment (all required forms)

Request for Internal Dual Employment (RIDE)

Employee Exit Checklist

Grievance

Staff Employee Grievance Form

 Leave

Advanced Sick Leave Request 

Advanced Sick Leave Repayment Agreement

Application for Reduced Teaching for New Faculty Parents

Certification of Health Care Provider for Employee's Serious Health Condition (FMLA-WH380E)

Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA-WH380F)

Certification of Qualifying Exigency for Military Family Leave

FMLA WH-384 form.

Leave Request Form

Request for Leave Transfer

Leave Pool Transfer Program.

Leave Donation Request

Leave Pool Transfer Program.

Payroll and Tax

  • If you need a reprinted copy of your W-2 Form, please contact our Payroll Office directly.

W4 Form

Direct Deposit Form

For the protection of our employees, this form must be delivered to Human Resources in person, by the person requesting the change.  ID will be required before changes are made.

How to Complete the Form and Frequently Asked Questions

CashPay Schedule of Fees

Deferred Compensation Policy and Form

9/12 month payment election form-IRS Code 409A

Frequently Asked Questions

Form 8843 Instruction

Resident v. Non-Resident

FICA Exemption

Non-Immigrant Forms and Explanations.

Personal Data

Name/Address Change

For College purposes only - please see Benefits section for PEBA form.

Personal Data Sheet

Workers' Compensation

Employee Statement of Injury 

Mileage Reimbursement

Supervisor Statement of Injury

Witness Statement of Injury