University of Florida College of Medicine

This web page is a repository for business forms used within the College of Medicine. You may download a copy of a form by clicking on the name of the form. Most of these are either Excel spreadsheets or Microsoft Word documents and/or macros. If you have a business from you would like to add to this collection, please send the form to us along with the name, short description and the format (Excel 97, Word 97, etc.) of the form.

Personnel| Property Records| Fringe Benefits| UF Foundation| Miscellaneous

The Forms below are in ".pdf" format. Download Acrobat Reader if you do not currently have it.

Personnel Forms


Form Name	Form Description	File Format	Date Received	Received From
AAMC Faculty Roster form	Used to report faculty information to the AAMC Faculty Administrative Management On-line User System (FAMOUS). Includes only faculty at the assistant professor rank and above--clinical and research tracks, scientists, and scholars.	Adobe Acrobat	02/04/03	AAMC Faculty Roster System
3400-3 Annual/Sick Leave Worksheet	Used to calculate Annual/Sick leave payment for clinical faculty paid by the VA.	Excel 97	03/16/98	T. Sporer Otolaryngology
Academic Personnel Transaction	For use on salaried and courtesy faculty appointments. (This form replaces the 250 & 251)	Adobe Acrobat	01/29/08	Administrative Affairs
Additional Pay Correction Request	Used for cost transfer of additional pay	Adobe Acrobat	11/2007	Finance & Accounting
Central Leave Balance Adjustment/Demographic Update form	Used to adjust leave balances and update demographics of leave system.	Adobe Acrobat	01/2008	Human Resource Services
Chair Leave Form	Use this form to get Authorization for Chairs Leave. Instructions	Adobe Acrobat	01/2008	Administrative Affairs
Asst Dean, Assoc Dean and Director - Leave Form	Use this form to get Authorization for Asst Dean, Assoc Dean and Director Leave.	Adobe Acrobat	07/2008	Administrative Affairs
Compliance Statement Form	Use this form for new USPS,Teams and OPS Employees.	MS Word	06/2005	Administrative Affairs
Confidentiality Form (HIPAA)	Use this form for all new Employees. Health Information Policy	Adobe Acrobat	06/2005	Privacy Office
Degree Confirmation Form	Use this form to complete a degree verification letter for faculty.	MS Word	05/25/99	Administrative Affairs
Direct Deposit Form for University of Florida Employees	Apply for Direct Deposit	Adobe Acrobat	02/2008	Finance & Accounting
Distribution form	To be used with all appointments to distribute salary or lump sum payments to a distribution account.	Adobe Acrobat	06/09	Finance & Accounting
D.O. Application	To be completed for physicians with the D.O. degree. Complete on an anual basis.	Adobe Acrobat	08/13/01	Administrative Affairs
Emergency Contact Form	Used to specify your emergency contact.	Adobe Acrobat	07/2007	Human Resource Services
Employee Exit Checklist	Checklist for employees who are terminating employment.	Adobe Acrobat	03/23/98	Human Resource Services
Employee Experience & Education Verification Form	Used for verification of work and educational experience for new USPS and Teams employees	Adobe Acrobat	01/07/03	Human Resource Services
Excluded Employee Time Sheet	For USPS salaried employees, time worked.	Adobe Acrobat	08/01/02	Human Resource Services
COM Exemption Request Form HSC Exemption Request Form	For salaried position vacancies;	Adobe Acrobat	06/26/08	Administrative Affairs
Extra State Compensation Request	Used for employees working more than one state position.	Adobe Acrobat	08/01/04	Human Resource Services
Faculty Assignment Report	Used for doing semester Faculty Assignment Report Form.	Adobe Acrobat	03/2005	Academic Personnel
Faculty Assignment Worksheet	Used for calculating the percentage of Paid Patient Care Faculty. To be use with the Faculty Assignment Report Form.	Excel 97	03/11/98	M. Busby Administrative Affairs
Faculty Compliance Report	Used for completing Affirmative Action on new Faculty	Adobe Acrobat	11/2008	Administrative Affairs
Foreign National Tax Information Form	Used for non-resident aliens to determine tax exemption.	Adobe Acrobat	09/2005	University Tax Services
Form 255	Used for OPS salaried employees. (Residents, Adj Professor, etc).	Adobe Acrobat	04/18/02	S. Harvin Administrative Affairs
Form 260 for benefits override	To be used when charging benefits to a different account than salary. Can only be used for FY ending 6/30/09 or before.	Adobe Acrobat	Sept 2005	Finance & Accounting
Form 270	Biographical Information Sheet for new faculty.	Excel 97	07/15/99	M. Williams Administrative Affairs
Form HR-50 ("4-in-1 Form)	Loyalty Oath, Intellectual Property Agreement, Substance Questionnaire, and Florida Retirement Plan Form.	Adobe Acrobat	04/30/99	Human Resource Services
Fringe Benefits Acknowledgement form	Used with new hires to notify of benefits available.	Adobe Acrobat	10/2007	Human Resource Services
FRS Designation of Beneficiaries	Florida Retirement System - Designation of Beneficiaries.	Adobe Acrobat	06/2004	Division of Retirement
Graduate Assistant Appointment Form (form GS-705)	Form used to appoint Graduate Assistants	Adobe Acrobat	01/2000	Academic Personnel
Housestaff Appointment Information Coding Sheet	NEW, TERMINATIONS, CHANGE IN DEPARTMENT,OCCUPATION CODE, & VISA CHANGES. Sample completed form Sample termination form	Adobe Acrobat	03/03/01	Housestaff
Housestaff List (New, Current and Terminating)		Adobe Acrobat	03/14/01	Housestaff
I-9	Used for new employees.	Adobe Acrobat	04/03/09	USCIS
Intermittent Leave Request for FY ending June 30, 2008	Used to request intermittent leave usage with extended leave of absence.	Adobe Acrobat	03/2007	Human Resource Services
Leave Application	Used when leave is taken.	Adobe Acrobat	08/01/02	Human Resource Services
Request for Extended Leave of Absence	Used to request leave of absence for USPS and Teams employees.	Adobe Acrobat	08/01/02	Human Resource Services
Letter of Offer for Residents	Contract between a medical resident and the College of Medicine. To be completed annually or for the period of the training.	Word 97	01/23/02	Housestaff
List of Five	Used for completing Affirmative Action List of Five	Excel 97	04/27/99	M. Williams Administrative Affairs
Medical Certification of Health Condition	Used with request for medical leave of absence for USPS and TEAMS employees.	Adobe Acrobat	09/2001	Human Resource Services
(NON-PROGRAMMATIC ACTIVITY)	Used for Residents when Engaging in Outside Employment	Adobe Acrobat	02/14/02	S. Harvin Administrative Affairs
Notice of Appointment	Used for Faculty Contracts	Excel 03	05/2008	Administrative Affairs
OPS Bonus Pay Request	Used to request bonus pay for OPS employees.	Word 97	09/17/01	Classification & Compensation
OPS Application	Used for temporary employment (OPS employees).	Adobe Acrobat		Human Resource Services
Outside Activities and Financial Interests Report	Used to report outside activities for Faculty and Staff.	Adobe Acrobat	04/2002	General Counsel
Performance Appraisal Form	Used for USPS & Teams Non-Exempt evaluation. Appraisal Rules	Adobe Acrobat	07/2005	Human Resource Services
Personnel Transaction Form	Used for USPS,Teams and OPS appointment changes.	Adobe Acrobat	01/07/03	Human Resource Services
Professional Liability Questionnaire for Faculty	Used only for Academic Personnel with Clinical Responsibilities.	Adobe Acrobat	11/2006	Self-Insurance Program
Professional Liability Questionnaire for Volunteers	Used only for Volunteers with Clinical Responsibilities.	Adobe Acrobat	11/2008	Self-Insurance Program
Post Doc/Pre Doc Fellowship Form	Used for Post Doc/Pre Doc Fellowships	Excel 97	12/10/98	M. Williams Administrative Affairs
Pro Forma Form	Used for Affirmative Action Faculty hires	Word 97	02/10/99	K. Mitchelson Administrative Affairs
PVA Change Request Form	Used for completing Affirmative Action PVA Change Request Form	Adobe Acrobat	10/2006	Affirmative Action Office
Request for Budgeted Position	Used to Create New LP Numbers	Word 97	09/28/98	A. Guillarmond Surgery
Request to use University Equipment/Facilities	Used for outside activities to report use of University Equipment, Facilities and/or Services.	Adobe Acrobat	10/2002	General Counsel
Resident Appointment Checklist	Checklist to Accompany Appointment on Residents in Training or Subspecialty Programs	Word 97	02/14/02	S. Harvin Administrative Affairs
Retirement Plan Acknowledgement	Used for New Hire Appointments	Adobe Acrobat	07/01/07	Human Resource Services
Retroactive Rate Form	Used for retro payments (salary increases)	Excel 97	03/06/98	A. Guillarmod Surgery
Sick Leave Pool Membership Application	Used for University Employees who wish to apply for sick leave pool membership.	Adobe Acrobat	08/01/02	Human Resource Services
Sick Leave Pool Usage Request	Used for employees that are members of the sick leave pool who wish to apply for use of sick leave pool hours.	Adobe Acrobat	08/01/02	Human Resource Services
Special Pay Increases	Used for TEAMS and USPS employees to request special pay.	Adobe Acrobat	04/2007	Human Resource Services
Special Terminal Leave Certification	Used for certification of terminal leave for part time employees.	Adobe Acrobat	01/18/00	Payroll Services
Temporary Appointment Letter - TEAMS	Temporary Appointment letter used for new TEAMS employees with temporary status. Choose appropriate option.	Word 6.0	03/01/05	Human Resource Services
Temporary Appointment Letter - USPS	Temporary Appointment letter used for new USPS employees with temporary status. Only current USPS employees are eligible for this appointment.	Word 6.0	03/01/05	Human Resource Services
Time Limited Letter - TEAMS	Time Limited letter used for new TEAMS employees.	Word 6.0	03/01/05	Human Resource Services
Time Limited Letter - USPS	Time Limited letter used for new USPS employees who are reassigning from a position in which they currently have permanent status.	Word 6.0	03/01/05	Human Resource Services
Travel Authorization Request	Use this form for travel authorization on Chairs, Assistant and Associate Deans. Instructions	Adobe Acrobat	01/16/08	P. Jan Eller Administrative Affairs
Download Unlicensed Physician Application Includes Laws and Policies (Gainesville)	Application for registration as an unlicensed allopathic physician.	Adobe Acrobat	01/18/08	S. Harvin Administrative Affairs
Download Unlicensed Physician Application Includes Laws and Policies (Jacksonville)	Application for registration as an unlicensed allopathic physician.	Adobe Acrobat	01/18/08	S. Harvin Administrative Affairs
USPS and TEAMS Position Description	Used to create new TEAMS and USPS position descriptions and updates for exempt and non-exempt positions.	Adobe Acrobat	06/07/04	Human Resource Services
Variable Compensation Form	Used with AEF voucher to pay moving expenses.	Excel 97	11/05/99	K. Mitchelson Administrative Affairs
Veterans Status Survey	Used for all new hires	Adobe Acrobat	8/17/09	Human Resources
Volunteer Worker Form	Used for volunteer workers.	Adobe Acrobat	03/2007	Human Resource Services
Volunteer Professional Liability Questionnare	Used for volunteer workers with clinical activities.	Adobe Acrobat	11/2008	Self-Insurance Program
W-4 Form	Used for new employees or name, address, or withholding changes.	Adobe Acrobat	2008	IRS

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Property Records Forms


Lost or Stolen Survey	Used to survey out lost or stolen property	Word 97	06/04/99	A. Guillarmod Surgery
Property Certification Form	Used to provide an accounting to property services, of equipment that is located in homes of employees, in clinics or other locations off campus.	Word 97	02/22/99	S. Goodman AHEC
Report of Survey	Used to survey out UF equipment	Word 97	03/06/98	A. Guillarmod Surgery
Report of Transfer Property	Used to transfer UF equipment from one department to another	Word 97	03/06/98	A. Guillarmod Surgery

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Fringe Benefits Forms


Form Name	Form Description	File Format	Date Received	Received From
AEF Annuity Agreement	Enrollment in the College of Medicine AEF Retirement Program.	Word 97	07/28/99	J. Smith Dean's Ofc
Application for Scholarship Payment	Used for requesting one-time payments for eligible faculty members.	Word 2000	03/13/06	J.Smith Dean's Ofc
Change of Status Reporting Form	Used for notifying the Dean's Office and the insurance providers of changes affecting an employee's insurance benefits; ie. marriage/divorce, birth, death, address change, termination, retirement, etc.	pdf	03/13/06	J. Smith Dean's Ofc
A.E.F. Life Insurance CHANGE OF BENEFICIARY FORM	Used for changing beneficiary designation for life insurance provided by College of Medicine	pdf	02/19/09	J. Smith Dean's Ofc
A.E.F. Group Life, AD&D and Disability Programs ENROLLMENT FORM: Clinical Faculty Basic Science Faculty Housestaff	Used for enrolling Faculty and Housestaff in the COM ING Group term life, accidental death and dismemberment and long term disability insurance programs sponsored by the College of Medicine	pdf	02/19/09	J. Smith Dean's Ofc
A.E.F. Group Health Program ENROLLMENT FORM: Clinical Faculty and Housestaff	Used for enrolling Faculty in the COM Humana Health Insurance Program sponsored by the College of Medicine	pdf	02/19/09	J. Smith Dean's Ofc

UF Foundation Forms

Please go to: www.uff.ufl.edu/intranet and follow the steps below to obtain a UF Foundation form.

1. Log in as guest
2. From the menu bar select library
4. Choose the form desired by clicking on a checkmark next to the form description.

Filling the forms out online: You will need Adobe acrobat 4.0 and Netscape 4.6
For help contact Ken Seebeck phone: 392-5982 email:kseebeck@uff.ufl.edu

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Miscellenous Forms


Form Name	Form Description	File Format	Date Received	Received From
AEF Travel Reimbursement Form	Used only for reimbursement of travel on AEF	Excel 97	03/06/98	T. Sporer Otolaryngology
AEF Voucher	Used to print an AEF voucher	Word97	01/28/99	C. Karle Dean's Office
Change Notice Request	Used when changes are needed to decrease/increase/close, blankets, travel, purchases orders	Word 97	03/06/98	A. Guillarmod Surgery
Disclosure of Financial Conflict of Interest	Must be submitted with PHS and NSF grant applications	Word 97	10/21/99	E. Feagle Biochemistry
FCPA Requisition for P.O.	Used to obtain a FCPA Purchase Order	Excel 97	10/28/98	A. Guillarmod Surgery
FCPA Voucher	Used to print an FCPA voucher	PDF	11/20/02	Fiscal
Limited Purchase Orders	Use to purchase items under $500.00.	Excel 97	03/06/98	T. Sporer Otolaryngology
NIH Biographical Sketch	Biographical sketch form required for NIH grant proposals	Word 97	02/03/99	M. Crews Biostatistics
PI Signature Page	PI Signature page for sponsored research projects	Word 97	09/15/98	A. Guillarmod Surgery
Information for Non-Research Related Contracting	Used to provide information for drafting contracts	Word 97	02/09/00	Elaine Burnham Dean's Office
Permission to Observe Patient Care	Used for all persons wishing to shadow physicians and/or other clinical personnel and to observe patient care.	PDF		Everall Peele HSC Privacy Office
Prescription Pads for Housestaff	Used to order prescription pads for Residents	Word 97	03/12/98	A. Guillarmod Surgery
Rental Car Justification	Used when renting a larger car or one not with the contracted carrier	Word 97	10/28/99	E. Feagle Biochemistry
Travel Voucher	Used for reimbursement for travel	Excel 97	03/06/98	T. Sporer Otolaryngology
Travel Authorization Request for Comp. Travel	Used to authorize complimentary travel	Word 97	04/21/99	E. Feagle Biochemistry
TR 20	Allotment Worksheet used for contract and grants	Word 97	03/06/98	T. Sporer Otolaryngology

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